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0 APPLICATION FOR SANITATION PERMIT Permit No. -__121 ---._'� 1 (Complete in Duplicate) �— Date Issued ------ Application _:_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. !OB ADDRESS AND LOC,ATIO �- �� '�✓ = �= Owner's Name-- : 'mo i.--- ' - ------ - -------------- - ------------- --- ---- -- - Phone------------------------- Address-----pr-�-----`-"" � ` Contractors blame ' ----------------------------- Phone Installation will sery®: Residence Apartment House E] Commercial ❑ Trailer Court E] Mote) E] Other E] Number of living units: ---- Number of bedrooms �__- I__- Number of baths -_ - Lot size Water Supply: Publics stem Ej Community system El � De th to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: Yes ❑ No �j 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 well..___7-7Distance fro fou dation---/___.------ Maigrial-----. ly No. of compartments------..�-....__-----•.Size--7__A_ _ .- -__--Liquid depth __1 -IV _ ---__Capacity-- - _ "---- Disposal Field: Distance from nearest well____ ,. __Distance Distance from foundatio ---1e--------.-.Distance to nearest lot line Number of lines----------;- ---- -- ----- -Length of each line------ 0----�t-------Width of trench------rte- ----------------- Type or filter material.-_ 5_1..Y' 1 Depth of filter material----1-_�- ----Total length-.---._ _ - `___________________ Seepage Pit: Distance to nearest well...-_____________ ----Distance from foundation--------------------Distance to nearest lot line------ ❑ Number of pits----------..---------Lining material--- -----------------Size: Diameter--- ----- -. Depth----------- - ------ n Cesspool: Distance from nearest well----------- _Distance from foundation -------------------Lining material-------- _ ___ --------------- ❑ Size: Diameter-- ---- --------- ----- ---------Depth_ ---- - -- ---- ------Liquid Capacify. ------- gals, -- --------- Privy: Distance from nearest w4------------------------------------------------Distance from nearest buifding-----.--------------------------------- ❑ Distance to nearest lot line_ --- ng -_--Remoden nd/or re -, - -__ � t :i-- _ 1 r ------------------ -- -- ---------------------------------------- -------- ----- --------------- ---------- -------------------------------------------------------------------------- -- 1 hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- C /1 ------ i_f�;�+ _, '� ----------- --- ------(Owner and/or Contractor) f - 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 - -- - ---------------------------- REVIEWED BY------ - - DATE BUILDING PERMIT ISSUED----------------------------- - - _ f ; DATE I - Alterations and/or recommendations------------------------------- --------------------- -- --- ---------_.. ..-----�-.-� --..-- . FINAL INSPECTION BY--------------- ------I---- ----- Date---- SAN ate---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California T=S--9-2M . Rerisou 1.57 r-P,co.