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r � . APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate( 3 S a Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. JOBADDRESS AN LOCATION ----- -----------------------,�---------•--------------------------- ----- ------------••- Owner's Name-------- ---'- hone7,t<V_ , P Address----------------------°�---�'-�---�-�--------------------'-- - --•--------------------------------------- ---•-•----•---------------- �' - Phone 4 .7�0 Contractor's Name------. - - -- ---- ---------------------------------------•-••-- _--------- 1 Installation will serve: Residence Apartment H OUSe,3 Commercial ❑ Trailer Court [I Motel [] Other 0 Number of living units: ___1Number of bedrooms _-- Number of'baths - ___-- Lot size °--- -.--- --- ----------------------- + Water Supply: Public system;VComl munity system ❑ Private ❑ Depth to Water Table,ft. Character of soil to a depth of 3 feet: S��New'Consfruction: Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ Y ❑ Y ❑ Y ❑ �I ❑ _ _ No � Previous Application Made: Yes ❑ No Yes ❑ No ❑ FHA/VA: Yes ❑ T F INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic T k_ Distance from?nearest well-----------------Distance from foundation___-----------------Material------------------------------------------------- No. of compartments ----Size-•-------------------------- ---Liquid depth-------------------------Capacity--_-------•-- ------ s osal F ld:— Distance from,neare'st•welf-------- --------Distance from foundation--------------------Distance fo nearest lot line----------------- Number of lines------------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material------------------------- o filter material___--- ---- -___--____Total length------------------------------------------ Seepage t: Distance to nearest weli__ �_ Y�£_ Distan rom foundation_______ ._______.. i tante to nearest lot Iy'�- � c� }IM -------- Number of pits___.--------------Lining material Size: Diameter ��_......Depth,,—_24..--�____________-_ - - Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material__._____--_____.________--_________- ' [) Size: Dia m ter------------------ --------------Depth----------------------------------------------------Llquid Capacity---------------------------gals. Privy: Distance from nearest well-_-_._..___________________________________._Distance from nearest building______-___ __. [] Distance to nearest lot line-`---------------=------ ----------------------- Remodeling and/or repairing (describe�--------------------------------------.--------------------•-----•------------- ----•--------- -------'------------------------------------- --- ------------------ - jatil. I I hereby certi that I here preparlication and that the work will be done in accordance with San Joaquin County ordinances, State I s, a rules d ref the San Joaquin Local Healt District. (Signed) ( Contractor ---------- ---- Tif Y:------------•- =--------•--------- --- (Plot plan, showing size of lot,` location of system in.relation t ells, buildings, et . can be p aced on reverse side). FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY-- -----------------------------------------------------------••----------------------- DATE--__ BY------------ ----- - ----- ----r------------- ------------------------------------ DATE '_ __.-------------------•--------1---------------- BUILDINGPERMIT ISSUED-------------- -----------------------------------------------–-------------------------------------- DATE-------�------------------------------------__------ Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------- ---------------••---------------------------------- ------- -------------------- -L--- _ ------------ - -- = � - - -- --------- ----------------::---- -------------------------------•-- •----------------- ------------------------ ----------------------------------------------------- ------------------------ -------------------------------- --------- --- ----- FINAL INSPECTION - ---------------------------------- Date-------------------------------- -------(!0 ---- - - ------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California t Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1-57 FY.CO.