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V 7 APPLICATION FOR SANITATION PERMIT � Permit No. i/ (Complete in Duplicate) a F� f Date Issued Application is hereby made to the San Joaquin Local Health'District for, a.permi},to construct and ins+all+he work herein described. t, This application is made in compliance with County Ordinance No 549: tSa^�� JOB ADDRESS AND LOCATION --------------------------y� �' �; - ------�------------------------1 N- Owner's Name---------- �j '--L _ - l_j "-=--- Phone_ f I-[ (L Address------------------------------------------------------- - - --- - - ----_---�-' `�•�----------------------------------------------�----•-------•----• ---•---------------- Contractor's Name............'�------ ----- = -- ------------------ •---- Phone-------- ------------------ 4 ----------- - ------------------------------------ ------ - Installation will serve: Residence �Apar+men+ House ❑ Commercial ❑ Trailer Court ❑ Motel LJf Other ❑ Number of living units: _ ----- Number of bedrooms ,'z.--- Number of baths __--_ Lot size --_ ------------------------- K Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _y' ft. !I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ )'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) r ��T r Septic Tank: Distance from nearest well_. �5,�-Distance from foundation____��___-____.Material_ _____________L___._____________� '> 4 No. of compartments-----2—-------------Size___[)---X_. Liquid depth...._ 7-.------_----_---Capacity.....w_ Di osal Field: Distance from nearest well__' a^j'_._Distance from foundation- A0 -___.Distance to nearest lot line_-___`z_-_-_-- ts, E � Number of lines________-cel_.__.t.�_.� _ Length of each line__I__�! ______t� _____..W'sdth of trench__��+'__�_________________a r Type of filter material--�i�`_'___.____Depth of filter material__ ___1✓ __ --------Total length_________________ _.__-_----_--- s. Seepage Pit: Distance to nearest well___'� _Distance from foundation-_-.E..0----------Distant t earest lot line-_-5.________, Number of pits__ - /------- __ Lining material__ f- "__CK ------Size: Diameter___ --e tn__.� --------- Cesspool: ___--_-Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material-_______-_-________-_-----____-_I� J� ❑ Size: Diameter-------------------------:---=-------Depth----------------------------------------------------Liquid Capacity---------------------- gals. Privy: Distance from nearest well----__------------------------------------------Distance from nearest building k ---- ------------------------------------------ 1 ' ❑ Distance to nearest lot line-�------------------------------ --- - Remodelingand/or repairing (describe)-------------=I--------------------------------------------------------------------------- -------•-------------------------------------------------------• . ------------------------------•--------•-•----- ••-------- --- ---------------- ---------------------------------•------- ----------••-------------------------------------------------------------------- ---------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. t (Signed)------- ��1l-/ 1-.r-- ` [' ------ --------- ----------(Owner and/or Contractor) By: (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----------- DATE---------'-----2-�- -a�----------------------- REVIEWEDBY-------------------- ------------------------------------------ --------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-----•-•---------------------------------------------------------------------------------------------- DATE------- ----------------------------------------------------- Alterationsand/or recommendationsi---------------------------------------------- -----------------------------------------•------- ------------------------------------------------------------- --------------:�-_---------------- ----------- - I-----------------------------------------------------------------------------------------------------------------------•--------------- -- ------ � '_-------- �'"y -----------------------------------=--------- ------- --- - ------ - ---- - -- ----I---------------------- -------------------------- ----------------------------------------------------- ------ - -- •----- ----------------------------------------------------------------------..---------- - _Ir-7 _/� - 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-M