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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to theSan Joaquin Local Healfh District for a permit to construct and install the work her esccrIbed. This application is made in compliance with County Ordinance No. 549. �fl -h 7` OB ADDRESS AND LOCATIONil ---- y C/ --------------------------------- ------------- •---------------------------------------- Owner's Name-------------------------- -� Address ----�-`---- -------/-1�--''�--------- ---------------- ------------- -----------••----••---------•--------------- Contractor's Name---t------------- ----_-------- Phone----••---------••---- Installation will serve: Residence ❑ Apartment House F] Commercial ElTrailer k ��rrMotel E] Other El Number of living units: --1----- Number of bedrooms -%--_ Number of baths -�-- Lot size __--R-qt- _-_______•-_ -------------------------- Water Supply: Public system [�] Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 2 Clay [] Adobe a] 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.) E Septic Tank: Distance from nearest well-07qA- ----Distance_from foundation-/ --- ------Ma erial No. of compartments---0"------------------Size° _':�'t -___.-_-_ Liquid depth--_. . -- -- 4"' C i --------Capacityl- ------------------ Disposal Field: Distance from nearest wefi--r►�--D--------Distance from foundation----/o_'_--------Distance to nearest lot line---S/---..--- Number of lines------ - �'Q--' ----- --Length of each line------�Q----------------Width of french---t-51-# ---------------_._--- "f p Type of filter materiae--I�rc --Depth of filter material--_��'_.'_---------_Total length-__/A-p--`_-_•--------------------- Seepage Pit: Distance to nearest well_---------------------Distance from foundation------------_-------Distance to nearest lot line--____---..-____ ❑ Number of pits----------------------Lining material---------- --------Size: Diameter---- Depth ' Cesspool: Distance from nearest well-_---------_----Distance from foundation------------------. Lining material-----------------------------_-_.- ❑ Size: Diameter--------------------------- -- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---_---------------------------- -------------Distance from nearest building----------------------------------- �. El Distance to nearest lot line---- __---------------- Remodeling and/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 andel regulations of the San Joaquin Local Health District. (Signed)----- /-�' ,a!",. 1L . _-- -------------------------- ----- -----•----- -----------{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 4 ---------------- APPLICATION ACCEPTED BY--- REVIEWED Y-_VIEWED BY---------------------- ------------------------------------------------ --- DATE �} BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE - ------------------ Alterations and/or recommendations:------------------------------------------ -------------------------------------------------------------- ------- ---------- ----------------- ------------------------------------------------------ ---------------------•-- ----------I------ ------------- -------------- ----------- ------------ FINAL INSPECTION SAN JOAQUIN 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 U59 F.P.Co.