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5� APPLICATION FOR SANITATION PERMIT 3,p Permit No. ) (Complete in DuplicateDate 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 No. 549. JOB ADDRESS AND LOCATION _ .. '17 -•--•-.....---------------- Owner's Name. , -07/4- ....... • -- ---- ............................Phone. Address ....... �d-d--- 4i -------------- --------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name --- ----'-----• ------•-------------------------------------- Phone ----------------------------------- Installation will serve: Residence.] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/ ------- Number of bedrooms j;L___ Number of baths z___ Lot size_1_fi_flf?_______--_-•_______________________ Water Supply: Public system ❑ Community system ❑ Private IV Depth to Water Table q.S_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JV Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No Ce New .Construction : Yes J% No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well --_-a�_y_a------- Distanc from foundation -_.1 A- n _.--_----M te_______________apac4. al- 4------ -------_------------------- p� _ sat No. of compartments ___----------------- Size---�-_-----'''-- { D1 __ : h ___- _ __ City- - -#.�-_ _ Liquid dept-- Disposal Field: Distance from nearest well__j47;7----- ...Distance from foundation_I_a............ Distance to nearest lot ryline..s_1--___--•_- Number of lines Length Length of each line --- A.�'_-------------------- Width of trench -_a'�_-____-_.______---------- T ________ Tpe of filter me, eria - --- Depth of filter materia!_-_,%-11___--_----Total length_ - -------------------------_-- y -Seepage Pit: Distance to nearest well ---------------------- Distance from foundation .................... Distance to nearest lot line ----------------- F Number of pits______________________ Lining material ----------------------- Size: Diameter ----------------------- Depth ___________________-_____________ Cesspool: Distance from nearest well_________________ Distance from foundation -------------------- Lining material ____________-________________________. ❑ Size: Diameter--------•---------------- ------Depth--------------------------------------------------- Liquid Capacity ------------------------ ... gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------------------------------------ 0 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 regulations of the San Joaquin Local Health District. (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---- 2, -,S %---------------- ------------- REVIEWED ---------- REVIEWEDBY -------------------------------- ------------_------------------------------------------------------------------------------- DATE --------------------------------- -------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE ------------------------------------------------------------- Alterationsand/or recommendations: --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------- ------------------------------ ------------------------------------------------------------------------------------- �g FINAL INSPECTION BY: --- Date ----"-4 _! 4--._7.7 `s l ---------------- ------ 130 South American Street Stockton, California ES -9-2M Revisea 1.57 F.RCO. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California