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APPLICATION FOR SANITATION PERMIT � Permit No. _�U___ _S- _____ om lets in Duplicate { I p P } Date Issued --.--1----lr--- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the w°rk herein described. This application is made in compliance wit C unty Ordinance N . 549.: ,� Zt ►�� �+ JOB ADDRESS AND L --------- -- ATION---- -- -------------- -------- '"' .. ...- - Owner's Name--------------- -=---�-- --- ------ -------- ------------------ --- ------ = ---------- phone------------------------------------ `` ---- Address--...-------------- /- - --------------------- - ---- Contractor's Name----------------- t�: V-� Phone !!i Installation will serve: Residence,�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of be .��Number of baths �__ Lot size ___�lt�__�__________�q�--1----------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table Y ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ ISandy Loam ❑ Clay Loam E] Clay [3Adobe W--"Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes Pa,"No ❑ FHA/VA: Yes R-'No ❑ i S TYPE OF INSTALLATION AND SPECIFICATIONS: S {No septic tank or'cesspool permitted if public ew, r isavailablewithin 200 feet.} 1 Septic Ta.k: Distance from nearest we Distance from foundation d -- ---- - ---------- _____:__.Material.__ 200 No, of compartments______c .-.__- ____ Size_. __XJ�--__.___Liquid d`pth___1�__,lg-- '=-'----Capacity_____ Disposal Field: Distance from nearest wel Distance from founclationA... -...._(_Distance to nearest lot line-.________• Number of lines__________-- -- ------ Length of each line__, ____�,�0, ____.Width of trench-____p2_f�____________________ 410 s of filter materiaL$-- _ __ ____Depth of filter material_____ --`---.-Tonal length______ ------------------------ Type Seepage it: Distance to nearest wel 1 1__DisfanceO�Amfodation__7.�_________-Distance to nearest lot line,-___�_-____Number of its Linin materialP i P Size: Diameter _ __________De th___ l Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material--------._____--_---__________.__-__. --------------------Li Liquid Capacity --------------gals. ❑ Size: Diameter i Depth q P Y 9 Privy: Distance from nearest well---- ---------------------- -------------------Distance from nearest building-----.---------------------------------------- I` ❑ Distance to nearest lot line------------------- --------------------------------------------------------------------------------------------------:----------.------------ l ' -------- ------------------------- ---------------------=--------------------------- � Remodeling and/or repairing describe]:_.-____-_._� ""�„ _ -- --------------- \ ------- ----------------------------- •------------------------------------- -•-------------------------------------------------------------------------------------------------------------------••-"-------------------------- k , I hereb c tify that I haverepared this application and that the work will be done in accordance with San Joaquin Coun#y ordinances, t law and r s nd regulations of th San Joaquin Local Health District. -- ---------- (Signed) • caner and/or Contractor) ----- BY= ------ ----- - - ---------------------------------------------------(Title)--- --s--------------------------- ----------------- (Plot plan, showing size of lot, location of syst n relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE-=_-----------------_------------_------------------- REVIEWED BY DATE �--------------------------------------------- ---- BUlLD1NG PERMIT ISSUED - DATE Alterationsand/or recommetions----- --------------------------------------------------------------------------------- -------•-------------- -------•-------- ------------------- ----------- --------------•--- I ----------;-- k � w --`------f---— --------- -----1 {��-)----- ----------- ------------------- -------------- LLA - ----- --- -- --- ---- - ----- - --- - ----------------- 1 ___________________________________ ______ _____ _ ____ __ __ __________ ____ ___ _______________ ____ - _ -_ _ r_---.---------_________________--_-____________ r� j _ ______________________________ ________----------------------------------------------- Date ___________________ __ ______________________ FINAL INSPECTION BY:------:- I1/�� Date----- _I. _ - _. I ------------------ ------------------------------ L 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.