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,APPLICAT)ON 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. } e•with County Ordinance No. 549. This application is made in compliant l � � � OCA I JOB ADDRESS AN LO ATION_. __ - =------------ ---- Owner's Name________ :�`'hvw 1 � - -------------------------------- Phone- Address---------------------- 3---- ------ -----•--------- �-- `----- -------------•--•--------------------------••----T�------•-------------------•---------------------•-------- � Contractor's Name------ --C'LM -- _�. _(.. �----------------- Phone. Installation will serve: Residence'' Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -___ Number of bedrooms --0- Number of baths _f_____ Lot size . _______________________ Water Supply: Public system Commuriity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: Yes ❑ ,N& New Construction: YesJ�o E] FHA/VA: Yes E] NOX j TYPE OF INSTALLATION AND SPECIFICATIONS: #( (No septic tank or'cesspool permitted if public�ee er is available within 200 feet.. Se tic Tank: Distance from nearest well-Y�1 ..... istance from ound tion -[I---------•--.Material.------•------------------------ ----- ----- ---------- V ---- No, of compartments Q Size_____ _ __{ �_Liquid depth____ __ -------- _____ { Disposal Field: Distance from nearest welFd� Distance from foundation_ ,o----------Distance to nearest lot _ Number of iines___�___ __'_ t � � _ _ _ _ _ff__ Length of each line_____-__��___-_..Width of trench_____��__________________ ,..r Type of filter material___ ?__ _ff Depth of filter material ___________Total•-leng�h______f:-( _�______________r_ 1. See a e Pit: Distance to nearest well_ . - lx_Distance f o fun ation____: __�_._.__Distance to nearest lot line_____ _._ �• pg _ � r• Number of pits__p2____._______Lining material___ Si e: Diameter_____ -(�6epth___�_-____________________ f Cesspool: Distance from nearest well_________________Distance fro foundation------------------- material____________.______________________ O ❑ Size: Diameter-----I-------------------------------Depth----------------------------------------------------Liquid Capacity--- -----------------gals. .5 Privy: Distance from nearest well_________________________________________________Distance from nearest uilding-----------------I-------.---------------- ❑ Distance to nearest lot line-------------------------------- --------------------------------------•------------------------------------------------------------------ Remodeling and/or repairing (descrie):------------------------------------------------ --------------------------------------------------- ------------------------------------------------ -------------••-----------------------------------------------=. - - --- -- ------- ----- --------------------------- - ------•----------------------------• ------•---------------------•---------------------------•--------------------------------------------------- I hereby certify that I have pr pa ed this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws d rules nd regulations of the San Joaquin Local Health District. (Signed)-� - -- --- ---------------- --------- -- --- - ----------------------------------•-------------------------------------------------------(Owner and/or Contractor) By: ---------------- -----------------------"---------------------------------------------------------•---------------------------(Title)------------------------------------------------------- ----- 1 (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- ---------- DATE- { i REVIEWED BY------------------------------------- ( DATE_ - --------------------- BUILDING PERMIT ISSUED----------------i-�- ---- = ---- -- ----------- - --------------------------------- DATE Alterationsand/or recommendations:l--------------------- -------------------- ----------------------------------------------------•---------------------------------------------------------- ! _ - --------•--------•-----•---•-------------------------------------------------------------------------------- ---------------------------------------------------------------------- ----------- FINAL INSPECTION BY:--------- �•--- -----_-- • -- -- ------ --- -- ---- Date------ -� --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.