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Permit No. APPLICATION FOR SANITATION PERMIT "Appric (Complete in Duplicate) L Date issued---,-_�-��-��-'--- 1 n ishereby 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 Oounty Ordinance No. 54�.� JOB ADDRESS AND LOCATION___;2-1-9-'1�,e' -----• ------ ------------------- --------------------------------------- P -0 -- --- Phone----------- --------------------•--- Owner s Name-------- ------- 7v' -------------------------------- -------------- - Address ------ e!�-•-- - -...- --------- Contractor's Name----- -- Phone--------------------- ll't--- - ,_- Installation will serve: Residence []Apartment House + Commercial ❑ Trailer Court Motel ❑ Other g? � Number of living units: _l.____ Number of bedrooms J__-- Number of baths _�____ Lot size N g Water Supply: Public system �ommunity system ❑ Private E] Depth to Water Table _:__ _,_ ft. Character of soil to a depth of 3 feet: SandGravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [ to ❑ FHA/VA: Yes ❑ No [�^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Q------- V �t�riaAl ---------- Septic T Distance from nearest w�e}ll_ ___d�__ Dista �e fr�n}�founda�t� n____ _ / goorNo. of compartments -----,1.-'-- - ----------Size. -, k y ------i% --Liquid depth----- ---- -----------Capacity------- Disposal field: Distance from nears well '�____ Distance from foundat' n__!__Q-1 j_ .__ a�tance to nearest lot lire_ _____________ Number of lines_____ _______ ___________ ______ Length of each line_ psi _3ti1 idth of tre mit___ Type of filter material___- epth of filter material-----/?__e-_______Total length / Seepage Pit: Distance to nearest welt___ _ ____- __ stanc ro u a}ton_�� (-.. is anc. to nears flat lif----��3------- of pits_--_�------------- Lining material _ce: DiameteDeptn__a---------------------- Number Cesspool: Distance from nearest well ----------------- Distance frorri foundation--------------- round Capacity ________ _______gals. ❑ Size: Diameter-------------------------------------Depth--------------------------------------------------L q p Y Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building______-_ ---------- ❑ Distance to nearest lot line ------------------------- --- ----------------------------- Remodeling and/r repairig (d scril -------------------------- ------------------------- /------ :� --------------------- -------------------- ------------------------------ --- -------- ----------------- ---- el U ---------------------------- - r ---------------------------------------- ------------------------------------ I hereby certify at I have prepared this application d `that the work will be done in accordance with San Joaquin County. ordinances, State laws, and rules and regulati of the San Joaquin Local Health District. ----- -------------------------------------------------- X'S By:— ------------ 7 ------------ -------- ---------------------(Owner and/or Contractor), ---------------------------------(Title)------------------------------------•--------------------------- (Piot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------------------------------ - -------------------------------------------- DATE------------------- - REVIEWED BY----------------------------------------------------------- ------------------------------------------------------- - -- -- - ----------------------------------- -------------------------- DATE-------------- --- ;r= --- ------------------------ BUILDING PERMIT ISSUED ---------------------------------- ------- DATE--------- ----� ------------------------------------ recommen atlons-- ------- -- ----- ------ ----- . --- ---------------------------------------- Alterations-and/or 1P o`----- --- c� f z - --------- ------------------------------• . --- T _________________________________��' D FINAL INSPECTION BY:.__--- --- -----------------ate r --- +}� SAN 'it LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5 -9-2M , Revised 1.57 F.P.CO. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California