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y1 ��. APPLICATION FOR SANITATION PERMIT Permit No. 1- _✓.: q,� 5� ` (Complete in Duplicate) v` Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install w herein described. This application is made in compliance with County Ordinance No. 549 j %` JOB ADDRESS AND LOCATI N� n ---- ------•• . --- r ---------- Owner's Name-- L �1E�B7 �Y --•---------------------------------------------•--------------- Phone----••------------------------------ Address--------- ------ - -- -- ---------------- ----------�' S Contractor's Name -----------I——------- Phone--�. 1"-7jC Installation will serve: Residence 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms °iL-:_ Number of baths __/-___ Lot size ----k!Fx--- Zi--- __________________________ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table !VP- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ 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 Distance from foundation...f_o...........Material------ k!-----------------_--_._.___-. No. of compartments_-..____z-__-----------Size__.?- ___Liquid depth__-____�.r____________Capacity__.8'4�._ - �� Disposal Field: Distance from nearest well__.:__— _____--Distance from foundation___ ______________Distance to nearest lot line----------------- 0p Number of lines-------------/--------------------Length of each line_____.____70-__--______.Width of trench__-_. '�?Cf &P Type of filter material---Xo-,(-_____Depth of filter material__��------------Total length--------f o_.'______________________ 5'6 a'�&it: Distance to nearest Aell----------------------Distance from foundation----1:'J.---.......Distance to nearest lot line--4.______- ® p g (--- �--- C----------Dept h........4' Number of its_____ _________.Linin material_____%�o_�. _ Size: Diameter___.X Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------.----------------------_._-_-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. \j Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_______-_.__-_________---__-_,_____,.__:. ❑ Distance to nearest lot line---------------------------------------------------------------------- Remodeling and/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, arjq rules and regulations f the an Joaquin Local Health District.-l (Signed) ,� ---------------------------------------------------(Owner and/or Contractor) By:---------------------------------- �--------- ---- ----------�-------------------------------------------------(Title)--•--- --•--------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- - --- ------------- ------ --------------------------------------- DATE----- ,.� REVIEWEDBY------------------------- --- ------------------------------------------------- DATE. .� -- BUILDING PERMIT ISSUED----------------- •----- --- --------------------------------------------------------------- DATE----------------------- --- -------------------------------- Alterationand/or r mmendations------------------------------------------------------------------------------------------------------------------------------------------------------------ --•----- ------------ -- - ---- ------------ b ------ --- -.,...------�--------------------------------------------------------------------- d l --------------------------------------- -j- -- -__ -----_----- --------------------------------------------______________________________________________________________________________________________ FINAL INSPECTION BY---------------- --- -----------------------------------•------ Date.----- f ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.