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APPLICATION FOR SANITATION PERMIT Permit No. _.rl...zo._..., (Complete in Duplicate) ! 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 LOCATIQ -- __ ✓..- ' ......... , X- _. Owner's Name .. � /� /� - ----------------------------------------- Phone.................................... Address-------�.--f ... .1.11....JI--------------- _.------------------------------------------------ Contractor's Name__._.*!%&%9**,z/w------------------------------------------------------- ...................................... .................. Phone................................... Installation will serve: Residence& Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other ❑ Number of living units: Number of bedrooms ...[_.. Number of baths ---I--- Lot size ......... ........................ Water Supply: Public system ❑ Community system ❑ Private-K--Depth td Water Table 4.9. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IR Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No's 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____ a Distance"from foundation.._.. �r No. of compartments---------2 ,_.------_-Sze. n 1 Q ... .......Liquid depth----- ---------Capacity.. S v-.o--------- p .Distance from foundation-__. line.-If Dis osal Field: Distance from nearest well +�..�}.�.._.f�istance to nearest lot ........... Number of lines________ __ ____ _______ Length of each line-----J6Q _-..___--_Width of trencij 24' Type of filter materia _ /A+L ®epth of filter material..../If..........Total length... .__.._ -•------------------ Seepage Pit: Distance to nearest well_____ ______________i6istance from foundation....................Distance to nearest lot line__.-__-_-----__-- ❑ Number of pits--------------- -Lining mai ial----------------------Size: Diameter____......------------Depth--------------------------------- Cesspool: Distance from nearest well_ ________ _Di1Faal c? from foundation __-______-_-.-_...Lining material-------------------------------------- 171 . _--_--_----________----.________❑ Size: Diameter--------------------- - --------Defth-• --------------------------------.......--------Liquid Capacity,...........................gals. Privy: Distance from nearest well...................... ,. ____--_.-_-_--__-Distance from nearest building_....................................... ❑ Distance to nearest lot line------ ------ • -----------------------•----------- -------••------•---- --'--•------------------------------•-----•--. Remodeling and 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 Ifealth District. (Signed -- ,el. t--. -- ------- - - -_----------- ------ Owner and or Contractor BY,---------------_-------------- ..........--- :.. --- }` ---- •------- -------- (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 ACCEPTEDBY ~ ------------------ -------- ------------------=--•----- DATE....................................................... BUILDINGPERMIT ISSUED.............................................................–....................................... DATE...............................................------------- . Alterationsand/or recommendations:--•----•--•--•-------- -------------------------•------•---....--------------•--........----------•---------•--------•-----.....------------........----- ----------•---------------------------------------------------------------- •--......-----•----------•--••-•---•----------•-----••---•---••-----------------------.......--------------------.--•...-----......----•----•- --------------------------------------------------------------------•---------------------__...............•---------•----------............................................... ----------------------•------------ ----------------•-.....................................................................................................•--•------...---•--......•----•--•-----------•••--•-•------•-••---•-•••----------•----•-------•------ --••----------------------------------------------------------------------------------••--•--••---•--•--------•---•----•--•-------------------------•--------------------.-------------------------------------------------- FINAL INSPECTION BYFlo--:.4-2 -------------•----------. 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 ES-9-2M : Revised 1.57 F.P.CO.