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1 c� q To ``.4'` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) � Date Issued _______--_�__�--- 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 No549. JOB ADDRESS AND L CATION------- . .–e-— _~ - '� Owner's Name------- - ----- ----------------------------------- - ------------------------------------- Phone------------------------------------ Address----__------------- --------------- -- - - -- Contractor's Name---------------- `y- ------ ---- ------------------------------ ------=------------------ ----------------- Phone---------------------------------- ,. ii Installation will serve: Residence &--`A`partment House E] Commercial) ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _Z.- Number of ;baths!-/.- Lot size ±-_p-, - - - ------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table '✓-_It. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ flay Loam ❑ Clay ❑ Adobe PH"'H' ardpan ❑ Previous Application Made: Yes E] No ��New Construction: Yes � to FHA/VA: Yes ❑ No P - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well._._'__✓"'------Distance from foundation----AP. .....Material---------------__ ______ ______'_________. No. of compartments------.-_----------------size--- __ __ a..Li wd depth�� f 1► �q R� -- � �---------Capacity--- -Qp------- Disposal Field: Distance from nearesft well-""'�"' `"Dist ance'fF6a foundatio ____1�_--____.Distance to nearest lot line_____--_. Number of lines-------/---_- _Length of each line_______ --------�-�------ - -t�-�-------------Width of trench------ - --- Type of filter material_ _ __ __________Depth of filter material _ �!�___Total length________ _ _�-__..-________________ f 1 1 Seepage Pit: Distance to nearest well _,�,______ ________Distance from fof�ndatiorh__ _ Distance to nearest lot ime_ ____.__ g1rt.+G."�Site Diameter--- ------ Dept [� Number of pits-----�-------------Linin mate ria - ---_--�- .�� h___ ------------___--- 1 Cesspool: Distance from nearAst well-----------------Distance from foundation--------------------Lining material___.____._.____.-_-_____.___________. ❑ Size: Diameter--------- ---------------------------De th---------------- --- ---------------- -- -Liquid Capacity gals, Privy: Distance from nearest well-------------------_------------------------- _-.Distance from nearest building------------------------------------------ F1 Distance to nearest lot line----------------------------------------------- ------------------------ ------------------- ---------------------------------------- Remodeling and/or repairing (describe)}------------- -� ------------------------------------------------------- ----------------------------------------------------------------------•----------------- •------------------------- -----------------------------•--------••------------------------ -------------------------------------------------------------------11 -------------------------------------=f 1 li ! hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. 1 (Signed)----------------- - - lof ----- --- ---------------------------------------------------------------------- ----------------'�r Contractor) . ------------Title(Plot plan, showing size of I ocation system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- -------------- ------------------------------------- DATE------------------- -_---------- -- REVIEWEDBY--------------------------------------------------------- - ----- --------------------------------------------------------- DATE----------------------- ---------- ----[------------ BUILDINGPERMIT ISSUED--------------------------- - - - --- - ------------------------------------------------------ DATE---------------- ----- -- ---------------------------- Alterationsand/or recommendations---------- -- --- -- -----------------------------------------------------------------------------I----Z-------------------------------•---------- c r --------------------------------------•-------- ------ ---- ------- ':::::_ -- ____:::::--:::_-- ------�-- ------- _---- ----------------------------------------- - -----::::::------------------------------------------------ l FINAL INSPECTION BY . __-- - ----- ----- ---- Date------------------------------------------------- �AN JOAQUIN LOCAL HEALTH DISTRICT X1 . - 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , itevisea 1-57 F.P.CO.