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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in ) DuP licate pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install he worrkk herein described. This-application is made in.compliance with County Or ina c o. 549. 1DRESS JOB AND OCATION_.!___ � ¢ -_ = �r- .- Owner's __ Phone.------- - Address---------- ------------------ ---------- ~ - -- -- --------�`---•--•-------------'------- Contractor's Name__------------------------- .. -- - ------------------------------------------ - Phone Installation will serve: Residence [8"Apartmen# House E] Commercial ❑ Trailer Court ❑ Motel F] Other Number of Living units: _f--_ Number of bedrooms S. Number of baths Ar Lot size -7 x---AOS ------------------------- Water Supply: Public system P__`Community system ❑ Private ❑ Depth to Water Table _�V_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ I No [ New Construction: Yes YT__No ❑ FHA/VA: Yes E11No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank- Distance from nearest well__A" _Distance from foundation -_--- - 7 ` LTJ - Material----��--��-- ----- -------- No. of com artments--__- _-_ - p �-- ---------Size-� ---�-��-----Liquid depth ---- r � � Cepac,#Y � Disposal field Distance from nearest well-�''�_.Distance from foundation---- -_----__-Distance to nearest lot line._-�r_-�___ Number of lines--- . Len th of each line------ __ 9 ,' � Width of trench-------- Type-of � '� filter material-� 4 -. __,,V ___ Depth of filter material___ll,�--______-_Total length---__---___--- ---_ -- �. Seepage Pit: Distance to nearest well__!--? Distance fr m f ndation._-�___ f ....._..Distance to nearest lot line--. __-_ Number of pits----- ___________Linin material--l� Lining - -----.Size. Diameter---� �------Depth...... o-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-__.--___----.__..Lining material----- -------------------------------- El Size: Diameter---------------------------------------Depth-------- ------------- ------------- ------------ Liquid Capacity----•---------------- -----gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building - ❑ Distance to nearest lot line---__-- - ---- -=------------------------ --- --------------------•----------------------------- Remodeling and repairing (describe)---------------- I - -- ------------------- -- --- ----------- ----------------- -------------------------------------------- --------------------- ------------------------------------------------------------------ = '--------------------------------------------- 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 regulations of the San Joaquin Local Health District. Si ned F ( g 4,— - ----- - -- -- -------------------------------------(� By:. •------•------•-- `- ontract - �- - -------------------------------------------------(Title)--------- or) t (Plot plan, showing size of lot, locat of system in.relation to wells, buildings, etc., can be placed--on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- ------------------------------ - - DATE - --------- REVIEWED BY ------------------------------------------------------------- --- ---'- DATE-_�"'-----------------•- ----- ----------- -- ----------- BUILDING PERMIT ISSUED. DATE - - - - Alerati no s and/or recommenda'_tions: -----•----- �� - --• ----•---- _ ------ ------------- --- • --l-------------- :____A ---- ------------------------------------ --- _ - --- _40 - •-------------=-d-----•'_----__-_-.._"•--c_•---.--�_--------•---------_•-,--__. `' '------- --------------- - - -------------- ---------•---- ----------------------------------------------------------------- FINAL INSPECTION B -------- __ Date-------- --------------- 57-- 4. SAN JOAQUIN LOCAL HEAL DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1-57 F.P.CO- i 4