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FOR OF!FI E SE: '3-------� -�- Permit No. _ APPLICATION FOR SANITATION PERMIT - ��------r-- --- _ (Complete in Duplicate] -� ------------------- -,--- ------------------------ Date issued ....................... --------- This Permit Expires ll Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereinAescrbed. This application is made in compliance, with County Ordinance No. 549. ' -•- ----------------------•---- JOB ADDRESS AND LOCA I N.. �'( � -----SI,_..V --------------•-----------------------------------•----••------------ - Owner's Name_ Phone......................... ---------- LOW 4-) ---—--- •-- - ----- ------•---- .I�� . Address-------------- --•-` Contractor`s Name. Phone................ Installation will serve: Residence ❑ Apartment House Commercial [ITrailer Court ElMotel C] Other ❑ Number of living units: _.fPll_. Number of bedrooms --/0-• Number of baths __�_ Lot size 4_464,4-10-------------- Water Supply: Public system 9K1*Communify system ❑ Private E] Depth to Water Table .- f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(i"Hardpan ❑ Previous Application Made: (If yes,date...............__--) No New Construction: Yes ❑ No2j-,FHA/VA- Yes ❑ No �` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T-bnk;, Distance from nearest well_________________Distance from foundation---.-------------_Material------------------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid dep?tb--------------------------Capacity-------------------- Disposal 'Field- -•--•-•--------.---Disposal 'Field: Distance from nearest well----7:77 ____Distance from foundation............:.......Distance to nearest lot line................. T'4�� Number of lines_ ----- �� 9 D- -------•Width of trench---- .--------------........... Len th of each line___._____ Type of filter material, , -0 -----Depth of filter material_.. -4---------.___Total length.._, ............................. Seepage Pit: Distance to nearest well------ '-----Distance from foundation- Distance to nearest lot line Number of pits----- -------.----Lining material_-/,& --Size: Diameter__--. -__.,Depth__'1.2.,�-----•........... Cesspool: Distance from nearest well___--._-___-_---Distance from foundation--------------------Lining material-_______________________ _____ Size: Diameter------------ -------------------------Depth-------------------•--------------------------------Liquid Capacity------------_---------- gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- ----------- 0 ---_______-.--.______•-------------- -•. ❑ Distance to nearest lot line------------------------------- - -- - ----------- I , r --------------------------------------------_-. Remodeling and/or repairing (describe)------------------ Ii ------ -•-----•- I -- .----- --•----••--•--------------------------•------- ----------------------------------------------------------------•-------------...-------••---........--.-----....--------•--•---_._...---..._ _ - - ---------------�----------------------------.----------------------------------•-----------------------------------------------------------------------------'•--------•------- 1 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 aquin Local Health District. 1 �".' --- r �or Contractor) 1 Signed _ - �- ----- -- - - -- - ------(Title)-- .�� --- ---- - ----------------- By: d on reverse side). (Plot plan, showing size Of lot, location of system i anon to wells, buildings, a+c., can be place r OR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY____�_ -f-------- - -----��-'- --------------------------------------------------- DATE---1/1..._.--ar--`----=---------------------------- REVIEWED BY--------------------- ---------- •--------- ------------------------------------------------------- ------------- DATE.-----•-------------------------------------------•-•------ BUILDING PERMIT ISSUED--------- -----------------------• DATE Alteratto sand/o]r recommends+ions ..---- - ---- ----••-•----••----•----- f ------------- � � ..---- �- �� -- ---------------------------------------- --- L + -------------------------------------------------------------------- ....---•----------•------------ ---------------------------------------------------------- ------------------------------- -------------- ---------------------------------------------------------------------------- FINAL INSPECTION BY;....-� J ------ Date-------------------- ------•--. ..............I--------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street ; 300`West Oak Street 114 Sycamore Street 205 Wast 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 8-61 AtLAS I