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3j ,APPLICATION FOR SANITATION PERMIT Permit No. _ �_ ...- �j� (Complete in Duplicate) Date Issued 3/x�_��t,7 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 wit County Ordinance N . 549. JOB ADDRESS AND LOCAT N,0-17_,O� � ----- ---=--•----- Owners Name '� D Phone -c -r --------------------------------=Address.......... Contractor's Name__. --_ Phone------------------ ----•----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ___ Number of bedrooms __i(___ Number of baths '____ Lot size ._.___ _____ Water Supply: Public system ❑ Community system ❑" Private Z?'bepth to Water Table 1�?_ ft. Character of soil to a depth of 3 feef:1 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No 9�' New Construction: Yes ❑ No R�'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 r (No septic tank or'cesspool permitted if public sewer is'available within 200 feet.) r Septic Tank: Distance from nearest w ll_ ___�/ _____Distance rom foundation_` _Or___ __-------Mate�'al-_ ___-_: _lt�--__________________-. No, of compartments___ .._- ------------ -- ____�_� ___Liquid clepth____ -- Capacity__ '_ '–� Disposal Field: Distance from nearest well--Q--..__.._.Distance from foundation__et&__'_._._-Distance to nearest I t line---o � Number of lines____________ Len_______ ______ th�of each line___._ � � Width of trench____W-141 44 t k ff,ff g ?' Type of filter material//—— w_De t of filter material----`----------Total length.-_.____��_____-------------------- Seepage Pit: Distance to nearest well-_____"______________Dispa ce from foundation-___._T____..' ......Distance to nearest lot line_________________ . ❑ Number of pits-------------------- Lining 'Material-----------------------Size: Diameter-------------=-----------Depth_ ---- cesspool: Distance from nearest well------------------Distance from foundation---------------------Lining material________.__._______.______-________ F1Size: Diameter Depth ------------ ----------------------Liquid Capacity --.--------=--- galsZ s Privy: Distance from nearest well----------_-------------------------------------_-Distance from nearest building------------------------------_- ❑ Distance to nearest lot line-----=------- ----- _ „r .— . -- -----------�'-------- •- ... -- - > Remodeling and repairing fdescribe):_____._.__. _.-. 2� -----------------------------;------------------------------------.-••------------------ -------------------------•--••------------------------------- ------------------------------------------------------------------ --------- ---------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------- -----••------------------------------ 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, an rules and regul ions of the San Joaquin Local He th District. ov (Signed) - ----------------- --- - - -- ----=------ --- -- - -------------------------------(�r Contractor)-. 8Y= ------------------------------------------- -- ----•----- •----------------------={Title)----- ------- a (Plot plan, showing size of lot, locati of system in relation to wells,-buildings, etc., can be placed on reverse e). f FOR DEPARTMENT USE ONLY I APPLICAT ON REVIEWED I BY__ACCEPTED BY - DATE------ --- --- 3 BUILDING PERMIT ISSUED----------------------------------- - -- -- -----------------------------------------=---------- DATE--------------- � Alterations and/or recommendations-----------------��5'.------ -------------------------------------------------•---------------- ------ - - -- --------------------------- RNAL INSPECTION BY::.- Date . k � � � i SAN JOAQUIN LLOCAL HEALTH DI*RICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh,"C" Street ' Stockton, California Lodi, California Manteca, California Tracy, California Ta I6) ES-9-2M . Revised 1.57 F.P.Co-