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APPLICATION FOR SANITATION PERMIT Permit No. .�___ ...__ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___._ I �c.�--1.- 3 _ _ __________ _____ ______ ____ __ _______._ Owner's Name------A. F= et ----- Phone-------------- Address----------tx----31----------------- -------- ---------------------------------------------------------------------------------- --- Contractor's Name------ ----------------- _ ------ _, ,�,�,. Phone_ Installation will serve: Residence ❑ Apartment House ❑ CommercialZj_-TTai1er Court 0 Motel ❑ Other ❑ 1 Number of living units: ________ Number of bedrooms -------- Number of baths _______ Lot size ____________,_ � -----------------------•----------------- ----- f Water Supply: Public system ommunity system (] Private ❑ Depth to Water Table y4�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a_rrdpan ❑ Previous Application Made: Yes ❑ No Kew Construction: Yes ❑ No �... TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: t Distance from nearest well-0214from foundation---t`2?�....Material__16�_ r__------_ No. of compartments-------2.._-----------Size__4XA---'?-4--------Liquid depth_ 3/- ----- - ----Capacity----��-�------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot.line----------------- ❑ Number of fines ---------Length of each line------------------------------Width of trench. Type of filter material-------------------------Depth of filter material-----------------------Total length------- '" ----- Seepage Pit: Distance to nearest well_ 0^r-t,-Distance from foundat1on____,?42_'*"__Distance to nearest lot line.... Number of pits.._________________Lining material Size: Diameter_ �- -- ------Depth_.._L0__`------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.._______.____-__ ------------------ EJ Size:-Diameter------------- ---- ---------------Depth---------------------------------- ----------:..Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building ❑ Distance to nearest lot line----------------- Remodeling and/or repairing (describe):____________________________ _______ ----------------------------------••-------------------------------------•---------------------------------------•-------------------------------- -----------------------•------------------------------------------•----------------------------------------------------------------•------------•------------------•------------•----------------------------------- 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, (Signed)___ a "'------ ----- -- -- -- -------�. V, �°s - --------- ------- -- - Contractor) ----------------------------•--------•-•--------•------------(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--- ------ -3 , �5; -------------------------- REVIEWER BY ------------------------------------------------------ ----------------:---------------------- DATE------- --------- -- BUILDING PERMIT ISSUED------_---------------------- -------------------- ------- DATE ---------------------- Aterations and/or recommendations______________ , ----------I----------------------------------------------------------•----------------------------------------------- -------- ---------------- ------------------•-•------------- ---�----------------- - FINAL INSPECTION BY______________V _____ ryr 3 ------ - 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 10-52 Revised W-2100