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" APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _�_ ___M 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----7-74 ------ - -- -►� -•--- '�� - 0 ------- Owner's I Owner's Name--------- e- i------ / ' --- Phone --------------------------•- Address 1xv-------4, 1 - -------------------------------------- ----- ----------- - - -------------------------------------------------------------- - --- -------- Contractor's Name---------------------— - --- 1� Phone + Installation will serve: Residence ❑ Apartment House ❑ Commercial ®railer Court ❑ Motel ❑ Other ❑ Number of living units: __- __ Number of bedrooms ____:= Number of baths _ -_ Lot size ___1_,&6,1ZA---- ----------------------------- Water Supply: Public system MIrcommunity system ❑ Private 'Depth to Water Table zy ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2"THardpan ❑ Previous Application Made: Yes ❑ No o- New Construction: Yes ❑ No E- FHA/VA: Yes ❑ No Rj--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well________________Distance from foundation--------------------Material_______________.___________-------_--__._______- No. of compartments--------------------------Size--------------------------------Liquid depth--------- ................Capacity----------------1---- D�s osal Field: Distance from nearest well----0-r__Distance from foundation __ ---.Distance to nearest lot line-/Q.-___-___ Number of lines------- ------- ------ ---- -Length of each line-------f` t ----_--Width of trench----- ----:--- -_-_----- J'� �p L De th of filter material___.f- ra-------Total length______.f_10f7- -- 7 / Type of filter material_ _,L__ r p 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___________-------_____________-___. N ❑ Size: Diameter----- ----------------- -------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. cl ' Privy: Distance from nearest well--------------------------------------------- .._Distance from nearest building_-__-----------_____________________---- ❑ Distance to nearest lot line_________________ ____________ ___ --------------------- -------------I---------------------------------------------- -- --- --- - ---------------------------------------------------------------- ---------------------------------------------- ----------- _Remodeling and/or repairing {describe)_________________________ � ----- -- --•----------------------------•------------;--------------------------•------=---------------------------- -----••------------------------- --------------------------------------------------------------------------------------- ------------------------------------------ --------------------------------------------------------------•--•----------------------- I 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 regulati ns of the San Joaquin Local Health District. [Signed]_ -- -----------(QVor•Contractor) ------------------------- - - ----------- ----- By�----:----------------------••---------------- ------------ -- (Title) 0 �� ' (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATIONACCEPTED BY---- ------------------------- -------- -------------- ---------------------------------------- DATE--- --------------- REVIEWEDBY--------------------------------------------------------- ---------------------------------------------- ------------ DATE------- ..�+------------------------------ BUILDING PERMIT ISSUED----------------------------- DATE----------------------- -------' j Alterations and/or recommendations-------------------------- --- ------------------------------------ -------------------- ----------------------- ---------------------------------------------------------------------------------------------•---------------------•------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- -----------•-----•------------------------------------------------------------- -------------------------------------------- -- ------- ------------------------------- _ G FINAL INSPECTION BY:. _,;�� ------------------------------------ Date-----/--�- - I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street . 300 West Oak Street 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 FY.co.