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1vAPPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) . Date Issued .... Applicai i Lby 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 w;th County Ordinance No. 549. JOB ADDRESS AND LOCATPN------- --------------------------------- --------------------------------------------- Owner's Name.----- - ------------------- Phone_//�_? �77 -- - - - - ----------- •------- Address--- ---- - ------------ - ------- ------------- -------------------------- ---------------------------------------------------- Contractor's Name... - ------------ fC7 zi_lc----------------- -------- --------------------------------------------. Phone(;;, - ---------------- Installation will serve: Residence,[VApartment House E] Commercial [] Trailer Court [] Motel El Other E] ;7%,� X /j—0 Number of living units: -,/-- Number of bedrooms6--- Number of baths 4-L-n- Lot size - ------- ------------------------------------------------- Water Supply: Puldfic system 9,""Community system E] Private Ej Depth to Wafer Table 44. ' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam Ej Clay Loam 0 Clay [] Adobe .Hardpan E] Previous Application Made: Yes [] No �%w Construction: Yes El No R111`FHA/VA: Yes F-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance fropm nearest well___-__- 171 Na. of comartments.- ___ I. _. _. Distance from foundation--------------------Material------ ------- --------- -------------- ------- ---- -- Size------------------------------Liquid depth---------------- - -------Capacity------ ---------------- Disposal apacity----------------------- Disposal Field: Distance from nearest well ------------ - -Distance from foundation..__.....r---------Distance to nearest !of line----------------- F-1 Number of lines-----------------------------------Length of each-line.-.------------------------"-.Width of trench.----------------------------______ a Type of filter material--------------- -----Depth -Depth of filter material----------------------Total length-------_--------------•------------- Seepayle Pit: Distance to nearest well-__1U'A,� istance fyt?3A foundation----,-/,C--/---.Distanc.1e to nearest fof line ---------- Number of pits------ ----------Lining material---A4%' &7e: Diameter_ Cesspool: Distance from nearest well F1 Size: Diameter--------- Distance from founclation . .. . ............Lining material-- ---------------------------------- --------- ------------------Depth- -------------------------- ----- ------ Ify. -------Ucluld Capacity---------------------- -- -gals. Privy: Distance from nearest yell.__________________...._.._..-------.-.-___-- -Distance from nearest building.-___.-.__---_____-_ ------- --- Distance to nearest lot line-------- - -------------------------------- Remodeling and/or repairing (describe]:_-.-__-"----____- --------------- --------------------------------------------------------------------------------------------------- ------ - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- --------------------------------------------------------- ------------------------------------------------------------------------------I----------------------------------------------------------------------------- ---- -- - -------------- ------- ----------------------__------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 5 s of the San Joaquin Local Health District. (Signed)--- --------I-------I----------- ----- - -------------- --- ---------------..(Owner and/o Contrac r] 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--- / REVIEWED BY------------- ------------------ -------------------- --------------I--- DATE--------- ------------------- DATE------- 1� ----- ---------------------- -- - ----- BUILDING PERMIT ISSUED - ----------------- ---------------------- --- --------- DATE---- ------------- Alterations and/or recommendations:..__-_.. :. --------------------------- -------------------------- - ----------------- ---------- ------ ------------------------------- ---------I------------------------ ---------------------------------------- It- ----- -- ----------`----------- ---- -- ----------- ---- --------------------------------------------------- --------------------------I---------------------------------------------- ------------------------------------- ------------ ------------- ------------ --------------------------------- ----- ------------ ---- -------- --- --------------------------- ----- - ------------V1 --1- ----- - --- -I - - --- - -- --- ------- -- ------ -- -- --- ----- ------ - 7j -- FINAL INSPECTION By. ----------- --- --- ------------ ------------- ---------- Date--- SAN JOAQUIN L&CAL HEALTH DISTRICT f30 South Arnerican Sfreot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2K4 Royhea 1-57 F P.CO.