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APPLICATION FOR SANITATION PERMIT Permit No. . (Com(Complete in Du li e P P ) Date Issued This Permit Expires 1 Year FromVate 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 L� '._-j�l ..--• ----- -------- Phone Address------------ - -••• -------- ---•- Contractor's Name--Arx'�L .................................................--------------.................................................. Phone................................... Installation will serve: Residence jo Apartment House ❑ Commercial ❑ Tr9iler Court ❑ Motel ❑ Ot)her Number of living units: __i'____ Number of bedrooms __3__ Number of baths I_y___ Lot size 143A---_•-�:"�_i-........................... Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table iX ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JV Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous.Application Made: Yes ❑ No fn New Construction: YevT No ❑ FHANA: 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 w+elll-_-_0-----Dista ce from foundation-- O-"•.----.Material ----- 's - No. of compartments____.f! ________:____Size_-_3_"'_r__._._.___Liquid depth-_____4/--------------Capacity. . .....►__--._ i Disposal Field: Distance from nearest well-s$00 __-_Distance from foundation._/P Distance to nearest lot he `r Number of lines_ _./_.-__ __ Length of each line___.P6__.__�� Width of trench ,�� . Type of filter materia of filter material---/?------------Total length- Seepage Pit: Distance to nearest we ___ ___ _Distance from foundation....................Distance to nearest lot line______________.__ 0 Number of pits______________________Lining material-----------------------Sizer Diameter---._____--------------Depth------_--___--------------_---_-_ Cesspool: Distance from nearest well__---------------Distance from foundation--------------------Lining rrLaterial-------------------------------------- El Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity--•-•--•-----•------_---•--gals. Privy: Distance from nearest well-----------------------------------_____________Distance from nearest building-____ ___-__: ......... ------------ 0 Distance to nearest lot'line----------------------------------------------- ..................................... - -----•--•----------------------------------- Remodeling ----- ----- Remodelingand/or repairing (describe)---------------------------------------------------•--••--•••---•---•-•---••--••-•--•-•--•-•-••---------------•------•--------------•••---••---••----- ------------•----------------••------•---•------------------------------------------------------------------------------------------------------------------•--------------••--------------------------------------- --_----- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of + San Joaquin Local Health District. (Signed)--•- ! (Owner and/ r Contractor) By:------------------------------- • ---•--- ----•- (rifle)----------------------------------- ----- (Plot plan, showing size of lot, location of system in rela+ion to wells, buildings, etc., can be placed on reverse side) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------------------------------------------ DATEJ'-1O-G/-- REVIEWEDBY-------------------------------------------------------------------------------------•--------------------------------------- DATE----------- -•- BUILDINGPERMIT ISSUED--------------------------------------------------------------..........................------------ DATE ---- -- - Alterations and/or recommendations:------------_ -- -- --- ----- --------------•------- --- - ------•------•------•------ ------ ----- --------•--------- ------------------------------------------------------•----•---------------------------------------------------•-----------------------------------------------------....................................................... --------------------------------------------- --------------------••--- -----•--------------...._..-.----------------------_.-.------------------•----------------------------------------------------------------------•--- Z . r� FINAL INSPECTION BY:.. .... ............ Date------ - - --------------------------- - ------------------------------ 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 V59 F.P.Co. -