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SS APPLICATION FOR SANITATION PERMIT Permit No. .01. f (Complete in Duplicate) �q Data Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a instalk the work herein described. This application is made in compliance ,th County Ordinance No. 549. JOB ADDRESS A D LOCATION-- ,, i- --- ------i �---i ------- Owner's Name---- = -�_dt h� 11C -— = -------------- ... Phone--RL .-- 1 T. ..b--. n 4 --------------------`- Address------------------------------------------ -- --- ---- Contractor's Name-----------------`--------v_hl--- r------------------------------------ ---------- Phone.------------------- ------------ ------------------------------------------------- - Installation will serve: Residence 2r-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --J-___ Number of bedrooms --Z-'Number of baths -------- Lot size ----------------------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private El`�Depth to Water Table �- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q--qardpan ❑ Previous Application Made: Yes-a?,"No ❑ New Construction: Yes J_D/No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- # No septic tank or`cess ool permitted if Public s wail ble within 200 feet. Septic T k: Distance from neare-st well' p p p � � � --�:Distance from foundation--------------------MatenaL--____________--.---__-------__-______-----.. No. of compartments-------------------=-----Size--•-----------------------------Liquid depth------------------- ---Capacity-------- - . Disposal ield: Distance from nearest WO----5b_------Distance from foundation----/D---------Distance to nearest lot line�� Number of lines----I- '• __ __ ______ Length of each line--�Z,�_----�--P-7....Width of trench-------2. _----.------------- d Type of filter material------ ------------------Depth of filter material--- -_-____-__Total length-_--1t-A----.-:__---_--_----- :! t Seepage Pit: Distance to nearest-welL.--------__------------Distance'fF6m;foundation_:-_----------------Distance to nearest lot line----------------- tv ❑ Number of pits---------------------Mining material--------------_------`.Size: Diameter-----------------------Depth--------------------------------- 000 Cesspool: Distance from nearest well________ _____Distance from foundation--------------------Lining material------------------------------------- F1 Size: Diameter---------------------------------------Depth----------------------------- ------ ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------Icy � ❑ Distance to nearest lot line--- --------------------------------------------------------------- ---------------------------------------------------------------------- r Remodeling and/or repairing (describe):---------------------------------------------------------------------------;----------------------------------------------------------------------------- -----------•---•-------•-------------------------------------------------=-----=---------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------=--------------------------------------=------------------------------------------------------------------------------------------------------------------ -00- ------------------------------------ ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, and rules nd regulations of the San Joaquin Local Health District. {Si ned g )--- - -- ------------ -------- - --- -- - -- - - - --------------------------- ---------------------------------------------------------(Owner and/or Contractor) B (Title)__ -------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----H 11V".---------------------------------------------------------- DATE--------.--111470- REVIEWEDBY--------------------------------- --------------------------------------------------------------------------------- DATE------------------------------------- -- BUILDING PERMIT ISSUED----------------------------- --- ----------------------------------------------- DATE---------------------------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------- ------------------------------------------ -----•--------------------------------•-------•----------------•-------------------------------------------------------------------------------- --•----------- ------------------------------------------------------------- -------------- ------------------------------------ - --------------------------------------------------------------------------------------------------------------------------- -------------------- ---------- Date----� ..----~� ---- ------------------------------------ FINAL INSPECTION BY---------------------5------- �- -•-------- ~ --- ..-.._ 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 I ES---9---2M Revised 1-57 F-P.CO.