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\ APPLICATION FOR SANITATION PERMIT Permit No. ....f D.,g.. \ � (Complete in Duplicate) 3 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 No. 549. JOB ADDRESS AND LOCATION- -- ------- ------- ----------------------- -- - - -------•-----------•--------..............•.................................................... Owner's Name--------- �_ � ---- ---- Phone- s O � �_ 72 Address -- ----- - ------ ------- -- -------.. -.....,... --------------------- - - --- -- Contractor's Name----------- - - - - --------- .11r� --.-- _------- Phone............... Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms R---• Number of baths ../.. Lot size ../„f -- .-./f Water Supply: Public system Community system ❑ Private A--05epth to Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No 4?'� New Construction: Yes ❑ No I!T- FHA/VA:Yes ❑ No [; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public s�wer is available within 200 feet.) Sept*,"'ITank: Distance from nearest wel Distanc�e+f�°m foundatign ./ _._- . a *al _.. No. of compartments_____•-`_--f__Size..�/_((%_ _�f'` •Liquid depth-- p y.. 1 Ca city. ¢ Disposal Field: Distance from nearest well•o� __:_Distance from foundation Af---------Distance to nearest lot line... - Number of lines__--------- __---- Length of each line___,� '--------:Width of trencht� Type of filter material. Depth of filter material-----I fl. ._Total length--...AO''f..� .....:....... Seepage Pit: Distance to nearest well_ /}� _____Distance rpr ou ation__s �f ........Distance to nearest lot line 0 Number of its------ --Linin material/1—..j� Size: Diameter-.3S------------.Depth-----��..*............. Cesspool: Distance from nearest well---------------..Distance from foundation-------- . ........Lining material-_----------------- .................... ❑ Sizer Diameter-------------------------- ------ ---Depth_=----------_---__ .---------_--_---Liquid Capacity.......•....................gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----------............................ ❑ Distance to nearest lot line--------------------------------- ------- - ----- -• -------•. -------------------- Remodeling and/or repairing (describe): j / P g ( ................l. PI�� E --------------------------------------------------------•-•-------------•----•-----•----•------•-----•-• ••----••---••---••--••.-•-•- ...... ••--•--•----•...._• -------- ------------...... 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, d rules and regu ions of the San Joaquin Local Health District. Si ned -- ------ -- (Signed) js f _ t��o Contractor) ----------- By:--------- ---• / • ------------------------------------ ------ -------------(Title)-- ; --- ------- (Plot plan, showing sizeeot, ation of system in relation to wells, buildings, 'etc., can be placed revers FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- .-__ _-___.--.--. _ DATE REVIEWED BY..-•--•-----•--- --- -. :----.... . .----; „ ----- ----------- DATE ----- / "!!*i.. --------.---- BUILDING PERMIT ISSUED------•-------- ----s- ---- ------------- ---------------------------------•..... DATE• -••---•..•----.-•-- --- --- - ---- Alterations and/or recommendations:...................------------------------ -------_-------------------••----•--. •. •...- ............................................---•----- •..._ _• -_ _ - ----- _ __ FINAL INSPECTION BY:.__�1_ ----------------------------------- Date-_-_�-------�. Q......J7--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Celt Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1-57 F.P.CO.