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f APPLICATION FOR SANITATION PERMIT Permit No. .�_d�?. 0 (Complete in Duplicate) // sa :. Date Issued -_ 7------ -- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION-------- ------------- -M --- -. ------ ' + ----- Owner's Name---N.lt-• -------- ------------------------------------- ------------------------------- ---------. Phone---------------- ------------------ Address----------... [ fl / ---- 1,e__4------------------------------------------------------------------------------------------------------------------------- Contractor's Name- �r"��G��.L? •s�'�� ----------------------- ---------------------------------------------- ---------- Phone----------------------------------- Installation will serv�Residence A artment House Commercial Trailer Court Mot � p ❑ ❑ ❑ el ❑ Other ❑ Number of living units: --- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------------------ Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table AP ft. Character of soil to a depth of 3 feet: Sand X Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli--- .g---.--Distance from foundation--/a-----------Material_-ie'� -_---------_-_--------. V No. of compartments-..�-----------------size--------------------------------Liquid depth--------------------------Capacity... � -�.._-- Disposal Field: Distance from nearest wefi_--0� ..-._Distance from foundation---Ib----------Distance to nearest lot line.-•�7'._.-.. DNumber of lines-_.__.t - ---- Length of each line------d-0_---------------Width of trench.-.�•.V-*---------..-....--._-. Type of filter material - p __--Total length_.,j*V '�v ' ___-De_-Depth of filter material-a/ ��._____ Seepage Pit: Distance to nearest weft----------------------Distance from foundation-------------------.Distance to nearest lot line__--_----..----- A ❑ Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- -t Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.._______.---------.---------------.----- Distance to nearest lot line Remodelingand/or repairing (describe)---------- --------------------------------------------•------------------------•------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ---•--------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg ti s of the San aquin Local Health District. Si ned _W, 4 { 9 - -- ------ --- - ------- -- ----------------------------------------------------------------------------- Owner and/or Contractor) By • ...r_ 'y !,J --- ----- ---- ------------------------------------------------------•----(Title)----- ------------------ (Plot pla , s owing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- - ----_.-- -' ("��' - - - - ------------------------ - -- -- ------------------------------- REVIEWEDBY------------------------------------- ----------------------------------------- -------------------------------------------- DATE BUILDING PERMIT ISSUED.-...------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:--------------------- ---- -------------- ----------------•------------------------------ --- -----•----------------------------------------•-------------------------------- -----I----------------------------------- --------------------------------- FINAL INSPECTION BY:-, --- �-�- ------------------------- Date-��0 --` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Forth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO.