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01APPLICATION FOR _ANITATION PERMIT Permit No. (Complete in Duplicate) dA Date Issued __ _f pplictii n its ereby 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. k JOB.ADDRESS AND LOCA T N---- ---/,-)//----- --------------------- ------ ---. ---- - •------- ------------------------------------------------------------ Owner's Name v ="= --------- ---- ----•----------•---- Address ----/----- --- __----- -------------- Contractor's Name-------- ----------------------------------------------------- --- -------------------------------------------------- one----------------------------------- t Installation will serve: ResideApartment House ❑ Com ercial ❑ Trailed Court F] Motel F] Other F]r t Number of living units: __ __ Number of bedrooms _ Number of baths ._ ___._I Lot size ' rdd Water Supply: Public system ❑ Community system ❑ +Private Depth to Wafer Table Uft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loamn,& Clay loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous`'A Made: Yes ❑ Nc New Construction: Yes No ❑ FHA/VA: Yes ❑ No_1 ° TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I t �,eptiic T nk: Distance from nearest well-----------------Distance from foundation-------{____---___.Material___-.___-_-----------------------------_-___. C/1"�" ' No. of compartments----- --- -----Size--------------------- -----Liquid depth--------------------------Capacity-- Disposa field: Distance from nearest well______'_____._Distance from foundation_-___ _rt_____.Distance to nearest lot line_________________ Number of lines-----------------------------------Length of each line__-__.i-----------------------Width of trench--------.-------------------------- Ty -______-______-___-__-_ Type of)filter material____________________---_Depth of filter material,___.�_________. _Total length•------------------------------ _____.__ \' Seepage Pit: Distance to nearest wellL�4`�---------Distance from_f�ndationQ Distant e to nearest lot line--.4-4 O' j -r -o-ncl6t.---Size: Dia- eter Number of pits__a __________Lining material ,� ______-___Depth-----,l0__________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______.-__-._-________________--____ ❑ Size:rDiameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Dista'nce from nearest building--------------------.---------.--_.-_____. a ❑ Distance to nearest lot line-------------------------------------------------------- ----------------------------------------------I----------------------------------- Remodeling and/or repairing (describe): -__ ti .! '_?I.__ ..____ ---- ;/1__ i ---------------------------------------- ------- ---------------------------- ------ ----;------- -------•---------•------------------------------ --••---. ---------- - ----------- } ------------------------------•-------------------------------•------------------------------------------- __:_. _.___— _�. ._ t ------------------------------------- --------------------------------------------- I hereby certify that I have prep ed this applicat' n andt t the work will be done in accordance with San Joaquin County ordinances, State law and'rule regulatio of San J uin Local Health District. i t .b (Signed) -- ----- -- - - -- --=-- ------ ------ --- - _ --------------------------------(Owne r Contractor) By: (Title ------ - ------------- Y• - --- -------- (Plot plan, show size o of, I cation of sys em`in relation to wells, buildings, etc., can be placed on rev rse e. ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -------------------- - DATE 4 REVIEWED BY �a` -------------------------- ------ DATE i BUILDINGPERMIT ISSUED---- - ---t------------------------ --------------------``--------------------------------------- DATE Alterationsand/or recommendations-----------------------------------------------------`-------------------------------------------------------------------------------------------------------- -` ------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------_----------------------•- _ f ------------------------------------------------- ----------------------------------------- ------- ------- ---------------------------------------------------------------- ----- ------ -------- ---- •------------ `' FINAL INSPECTIONDate-----BY:--____-_ ` _ - 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 FRCO.