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APPLICATION FOR SANITATION PERMIT Z_ (Complete in Duplicate) Date Issued ._ �I��• . work herein described Application is hereby made to the San Joaquin Local Health District for a permit to construct and install-the . j. This application is made in compliance wiitth CountyOrdinance No. 549. Z < r.kj V. Tf ----------- JOB ADDRESS ANCATION--- ------••-- phone-__ ------------e ---- ,Owner's Name--- - -- -----------•-------•-----------� Phone-----------------........- Con#ractor's Name------ -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ---- Lot size ------f�.�---�'-,�.�------ ------------------------- Number of living units: -_�---- Number of bedrooms •Number De thhto Water Table-(} ft. Water Supply: Public system 5�_Commurtiity system ❑ „Private ❑ P Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam F71 Clay Loam El Clay E] AdobejD Hardpan ❑ uctiYes �No ❑ FHA/Up"YeS ❑ No�� Previous Application Made: Yes El. No ®= New Cbrnstr¢ on: J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer,is available within 200 feet.) Material____________________-- ,..i Septic Took: istance from nearest well_________________D-sstance from foundation__.:_____-___-_ Capacity----_--__--__--__ --_-_ f compartments -----------Size------•-- Lsgwd dap#h tance Disposal Field: -µ•ms D .ante from nearest weh ----------------Distance frog h line found width oftfre chest 10# line-------- ------.- p u "bar of lines Length of e Total len th -------------------- El- Ty�`f filter material-'______________________�Depth of filter materia------------------------ 9 Seepage Pit: µ Distance to nearest well __ _ / D++stance fr foundation'-9--d-.' oundation:- -d---k•--Distance to nearest lot line_�� --�-- l f { .r_�-.Dep#h { . Sze: Diameter-_-_. _ Number of pits------/-------;---•Lining material_-_- ) r - -Liquid p y r � Distance from nearest well---'------ -- ---_�-Depth DistanCe from foundation-------------_-_ mnCaping acity-----------=-----,--------gals' Cesspool: ❑ Size: Diameter_ 1, Distance from nearest building__________________________________ Distance from)'nearest wei4------------------------------------ - ---- ---- I Privy: ---------: _. ❑ Distance to nearest lot line--------:_-___--_-__-- - --------------•---------------------- --------•------------------------------------ Remodeling and/or repairing (describe}-------------=------ - -------_--_______.,._-_--- -------------------- ---------------- ---------------------------------- ------•---------•-------•------- ------ I hereby certify that I have prepared this ap application the San Joaquin work cal Heawill l be done District. accordance with San Joaquin CaUnty ordinances, Sta ws, and rules and regulations ----------------------------------------(O ner and/or Contractor ,. [Signed}_._____ _-- -- t ` • - ----------------gitle� SY� , n - - [plat plan, showing.size of lot, location of sys#em in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY, -- ------- ---------------------------------------------------- DATE --------- --------------------------- -- - APPLICATION ACCEPTED BY-_$�-------------------- •- DATE- ---- ---------- REVIEWEDBY-------------------------------------------- ------- ------ . ----•------------ ----- --- _ _ -' DATE----=-- ---- ----'---- ------- -•-----------------•------ BUILDING PERMIT ISSUED = �`' 1 � : ' :_ f'. --------------------- Alterations and/or recornmendations: e _+s_ sem"` - - -- ------ ---------------------- - - -` � ------- -- r • &_- _____________________________ --_ _-_ _-__ _-" -- -- ----- 1 _ __.___-__�_._ __----------------------- ----------------------- ______________________ _ ----------------- ------------------------- __ ______________ _______________ _______ _____ Date r--------------------------- ----- ---�-- FINAL INSPECTION 13Y---- ----- ------- --- ----------------------------- - I@ I SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street i 300 West Oak $+reef Trac California Stockton, California 130 South American Street Manteca, California y Lodi, California ES-9-2M , Revised 1.57 FY.CO.