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APPLICATION FOR SANITATION PERMIT Permit No. ._. -'�..!..__7_. (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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------�o / _- ----- ---. ,�1 / -------0 . ------- Owner's Name--------T�.�_-------- /-4-iY_of/----------------------------------- -------------- ----------------------------- phoney Address________________ r ..�j -----------------------•---•----------------------- Contractor's Name - Ld= I�v� —�a/1� f�✓------------•-- ---------------- Phone.&__- -0 77A%;� Installation will serve: Residence LK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms __r__ Number of baths I____ Lot size ------ ---------------------- 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 ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes ❑ No Ni New Construction: Yes ❑ Nog] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation,___----------------Material______.________.-_______.__.________-..__.-_____. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- / f Disposal Field: Distance from nearest well _____Distance from foundation----7� Distance to nearest lot line___;T0_____. Number of lines_____________ -___________Length of each line_________�z�-_ 7 Width of trench------ Type of filter material__ 0 ' ____Depth of filter material____. -- ---- ---- length-----------1 -_f--- _____-_____ 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_________________________________.._---.-. ❑ Distance to nearest lot line-------------------------------------- ------------------------------------------------------------------- ------- -- of Remodeling and/or repairing (describe):--------_. t------.•-� ---i- --------�'-�- -� ' �4.�- ---------------------------------------------------------------------------------------------------- -..------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances. State S. and rules a lations of the San Joaquin Local Health District. (Signed)----- �, ------ ---- -.------ s' __ /.S'- -•---------------------- (Owner and/or Contractor) P By:------ --- -------- --- -- - ------------------------------------------------------------------------(Title)--- ------- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------- -t --------------------------------------------------- DATE---- <3------------------------------------------------ REVIEWEDBY------------------------------------------------- ------------------------------------------------------- DATE ----------- -- 1 ------------ ----------- - BUILDING PERMIT ISSUED-------•-----•------------ ----•----------------------- ------------------------- DATE---- ---- ------<"- ----------------------------------• Alterations and/or recommendations--------- -- S -------- ---------------------------- --------- '-- ---- -2------=----�--°�"--------",------ �,3r� -------------------•------------------------------------ •----------- � �� ----- ------------ ' ---------- ------------------ --------------------------------------------I---------------------------- ----------------------------- -------------------- FINAL INSPECTION BY:______ ------------------------------------------- SAN -------- --- - - --- - --------- SAN 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 1.57 F.P.CO.