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�10\ .� �► xt APPLICATION FOR SANITATION PERMIT Permit. No. � Q f (Complete in Duplicate) . R� �) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein de?cribed�� This application is made in with County Ordinance No. 549. JOB ADDRESS AND LOCATION ------------W---- ---------------------------------------------- Owner's Name---------------= /lam= --------------- ------------------------------------ Phone------------------------------------ Address---------------------------4�� Ia'l ' Contractor's Name------------------- -- / --------------------------------------------------------------------- Phone------------------- -------------- Installation will serve: Residence ''"Apartment House ❑ Commercial ❑ Traileer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms _j_ Number of baths __/--- Lot size ----------- Water _ -Water Supply: Public system ❑ Community system 931** Private ❑ Depth to Water Table ' ft. C Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No gr New Construction: Yes RNo ❑ FHA/VA: Yes [Gy-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) k T Septic an : Distance from nearest well _____.Distance from foundation_----_ p -------- / ----.Material----��---�- - ------------------- [ � No. of compartments------t�-_____-___-_ __:___Liquid depth---t,�, ----------------Capacity....4�K -__ Disposal Field: Distance from nearest well -.-Distance from foundation___14. ....Distance to nearest lot line___ Number of lines---------i_� _-fP�'.-. -___Length of each line----,��1---- ''_Width oftrench___-- Type of filter material_/--/ Depth of filter material_1, '-_-__.___Total length-____-_-1-0=A_-.---------------- +' Seepage Pit: Distance to nearest well----------------- from foundation_-_ r�_____---D Distance to nearest lot line__�__________� � Number of pits_______%._______Lining material__/_-�..P_411! .Size: Diameter-�z ___________-__Depth /Y X a - Cesspool: Distance from nearest well-----------------Distance from foundation------•-------.__-_.Lining material__.-------------______--.____-____. ❑ Size: Diameter------------------------ -----------.De th---------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well------------------------------------------------- from nearest building-----_._________-______-____-__._-____. ❑ Distance to nearest lot line-----------------________-____________________ r Remodeling and/or repairing (describe):----------- ------------------------------------------------- ? 4 -----------------------------------------------------------;--------------------- `\ " I hereby certify that I have prepared this application and that the work will be done in accordance with;;,;Sa.nAJoaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. l ` w (Signed) -------- j =-------------- ---- ------- --------------------------------------- (Owner and/or Contractor) By:--------------------------------------------------------------- - - - - '- --------------------------------(Title)--- (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed-on'reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 5 ----- ------------------------------------------------------------ DATE - REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------- ------------------------------------- DATE---------------------------- Alterations ---- ----Alterations and/or recommendations:--------• ---------- ----------------------------------- ------------------------------------------- ----- ----------- T� K_----------- s ----- -- ---------;--=,-------•-------------------------------------- --------------------------------- ------------=.-..'---------------------------------- ---- ---------- --------- -----! FINAL INSPCLQN_BY Date------- ""��' "i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132"Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.