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APPLICATION FOR SANITATION PERMIT Permit No. ----- -------- �� ., • (Complete in Duplicate) Date Issued -------�_fm 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 ith County Ordinance No. 549. : Z`� t v.cJ = �`l 1�_ �� V ---------------- JOB ADDRESS AND LOCATION-------------------------------• --• - ---- - 43 Y ql Owner's Name___________________ �!(1 =L Phone_- ------------------•---- p �7s1.�✓ Address � = ------------------------------------- Contractor's Name T } h �� ' Phone------- -----------------•--------- Installation will serve: ,Residence 14 Apartment'House ❑ CommerciAl ❑ Trailer Court ❑ Motel ❑ OtherE]❑ • Number baths - ___ Lot size _____ /13 l'`� Number of living units: _1__- Number of bedroomsr3_ - ---- f � Water Supply: Public. system .0, Community system ❑ Private ❑ Depth to Water Table ____F__ ft. Character of soil to a dip+h of 3 fee+: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam [I Clay E] Aciobe�' Hardpan ❑ i Previous Application Made: Yes ❑ No 21 New Construction: Yes No ❑ FHA/VA: Yes ❑No,O' TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 0411 I i - Lllr �_ Septic Tank: Distance from nearest well Distance. from undation_-___� _____-Mate ----------- ______ ___________________ Qo Ca acit O No. of compartments_______2_t_..______Size____.-X - -` ^Liquid depth________`. --- i p Y Disposal Field: Distance from nearest well.___-`T—___Distance from foundation____ .©-____.Distance to nearest lot line_________________ N Number of lines-------- _ 7� ___.-A .-------Length of each line----------7�-------------Widfih of #ranch-------�'z, � ---------- Type of filter material_( -Depth of filter rnaterial_--------'�_--- Total length-------------L--------------------- Seepage Pit: Distance to nearest well___________________-_Distance from foundation--------------------Distance to nearest lot line____._----_____- ❑ Number of pits.---VD-----------Lining matevrial_t-------------- ......Size: Diameter-----------...... ----Depth--------------------------------- 1 Cesspool: Distance from nearest well__ ---______Distance from'foundationT _--;-Liait g material______________________________________ ❑ Size: Diameter------------------ ------ `- - ------Depth----------- ------- -- - Liquid Capacity- gals. Privy: Distance from nearest well ------------------------- Distance from nearest building_±_______.___-__---_______-_______---.- \�y� [� Distance to nearest lot liner-------------- - [ ----•----------••---------------------------------------------------------------------------- Remodeling and/or repairing {describe�:___________r_--- I k ------------- 1 I Vj 0 ------------------------------•- ------------------------------------••----••--------------------------------- " -------------•-------•------------•-------=----------------------------------•----------- ------------------- --------------------------------------1-------------------------I-- - ---------------- 1 --------- ---------------------------- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, State laws, and rules and-regulations f t e San_ Joaquin Local Health District. ---'--- -I (Owner and/or Contractor (Signed) __• ------- /"- Tale (Plot plan, showing size of lot. location of�sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY• � I BATE- - 'J�.. - APPLICATION ACCEPTED BY ;; z,a,�-- v.. - .. ' REVIEWED BY--------- ----------I --------------------------- DATE ---- - -- BUILDING PERMIT ISSUED-------------------------------- ------ ----------------- DATE Alterations and/or recd mmendati ons:_.»..,,...___ ----------------------------------------------------•"----------- ----- ----------- ------ - ----------f ._ ----------------------- -- -------- ,* -, , 1 ( ----------- ------ -------- -1- WFINAL INSPECTIOt -BY._- ------- --�--------- Date_- ---------------------------------•---- SAN JOAQUIN LOCAs. HEALTH DISTRICT 130 South American Street 300 West Oak 5lreefi -� 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revisea 1.57 F.P.CO.