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APPLICATION FOR SANITATION PERMIT Permit No. ._ 6.3_ a V�� in Duplicate) (Complete P I Date Issued .... Alv 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 LOC TION Owner's Name--------------- --------------= ------------------------------------------------ Phone-- -`z/, Address ---,>Y t r c._. -- --------- Contractor's Name- ---- / ---------------- Phone __'...:__. Installation will serve: Residence Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J__ Number of bedrooms __ :__ Number of baths _-_/__ Lot size ..__.._ - ____-_____.______-_.---__-_ Water Supply: Public system [B' Community system ❑ Private ❑ Depth to Water Table 2�!Z" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®r'Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes (��-'IV�o ❑ FHA/VA: Yes ❑ No ® -- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well___ _._'_._Distance from foundation---4Z-----------Material_____-�:-----------�-`.'__:_`__:'-:.�------- .. 'r No. of compartments___ --------------------Size.:__ ------w---Liquid depth___ �___----------Capacity. Disposal Field: Distance from nearest well,4?�_r__Distance from foundation__.___ ____Distance to nearest lot line__-__ ` Number of lines________f " ---_Length of each line__,', '---------------Width of trench-- Type rench � T ---- p g Distanocef to nearest(well r' Depth of filter material 1.�" ____Total length.____,rG'.-------- Seepage -----•_ Yp - See a e _-_Distance�irom foundation_///!_`..__..Distance to nearest lot line.... CK Number of pits__._ --------------Lining material._ f -------- Diameter-�_j............Depth----- _ ------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------- -Lining material_-___-._____--_.:_-___-____.-_______. ❑ Size: Diameter --------------Depth ------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------.__..--_-_--__-.-. ❑ Distance to nearest lot line - - Remodeling and/or repairing (describe):----------------------------_-------- ---•-----•-------------------------•---------------------•-------- •--------------------------------------- ------------•--------------------- ------------------- -----------------•------------q•----------------------------------------------------------•------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, ws, and ru0A11 ns of the San Joa uin Local Health District. Septic Tank So*� ') (Signed) - `� '- ---N46--- i � r Contractor] - Stockton, CORE / '`( Tale By:.----------------- ---------------------------------- -------------------- - d ` - -- - --- - - ------------------------- (Plot plan, showing size of lot, location of system in relation o wells, buildip§s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------- ------------------------------------------------------- DATE---------------- � --- ----------- REVIEWED BY-------------------------------------------------- ----- -� ----- - ------------------------------------------------- DATE---- - ------------------------------ UILDING PERMIT ISSUED------------------------- ------- ----- --------------------------------------------------- DATE---- ------------ - ---------------•-----•------ Alterations nd/or recommendations: -- ---- ------------------------------------------------------------- t' - ..................----- ......... ---------------------- y - --- - - - ------ - -- ---- - ---- - ------------------ -------------------- -- ----- --------- ------- - - - t. ll 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 1.57 F.P.CO.