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APPLICATION FOR SANITATION PERMIT Permit No. .__!�->-✓�• --• jk (Complete in Duplicate) Date Issued ?/4_/o 4_/o 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 A LOCATION-------cam'-�-�� -Q ........... - -------- - ---------- Phone------------------------------------ Owner's Name----- - -t�J`--=---R------ - - - - -----------�-------------------------- ------------------- --- Address----••--C 26 -------- Phone----------------------------------- Contractor's Name------ -----.�� ---- --- --• - --------561 Installation will serve: Residence [-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /-_ Number of be .-- _- tuber of baths ___1_- Lot size _____ -L Water Supply: Public system 5�__ Community system [IPrivate F1Depth to Water Table,_6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: Yes ❑ No Q_ New Construction: Yes Q;�,No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: tante from nearest well----------------- from foundation___________________.Material__________________.__________._____._ ___...___. of compartments------------ ------Size-----•--------------------------Liquid depth----------- Capacity ❑ tante from nearest weil_________________Dlstance from foundation______________.....Distance to nearest lot line_______._____.___ Disposal Field: ---------------------------------- ❑ ber of lines------------------- ------•--------Length of each line------------------------------Width of french. pe of filter material-------------------------Depth of filter material-----------------------Total length--------------------------- Seepage Pit: Distance to nearest well--,A from fouridation__�.0__f__.Distancerto nearest lot line__._.--�-- Number of pits---f-----------------Lining material--�i Diameter_-- .-- ----- Depth,---.- i ---------- ------ , Cesspool: Distance from nearest well------------------Distance from foundation------------.------Lining material___.______--________---------------- ❑ De th---------=-----------------------------------------_Liquid Capacity----------------------------gals' Size: Diameter-------------------------------------- P �. Privy: Distance from nearest weil----------------------------------------------- -Distance from nearest building-------------------------•---------------- Distance ❑ = to nearest lot lire--------------------------- --------- ----- --------------- ---------•------------------------------- -------------•------ Remodeling and/or 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, Stat ws, and rules and regulations of the San Joaquin Local Health District. Si ned _(Owner and/or Contractor) - --- ------------------------------ -- - s9 Plot plan, showin size of lot, location of system in relation to we (Title) j---------------------------------- By:. -------- ---- - ( p g y IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ---- DATE-------- -------------------------------------------- ------------------------------------------------------------ REVIEWED BY--------------------------------------------------------- -------------------------- , DATE------ --- --- ------------------ BLiILDING PERMIT ISSUED--------- - ---- DATE --- --------------- ---------------- Alterations and/or recommendations---------------------------------------------=----- ------------------------------------ •------- ------------------•---------------------------...----------•---------------------------------•-------•------.------ ------------------------ ------------- •--------- FINAL INSPECTION BY:.______.-'�--�----�-� = Date---- -----------------------------� 5 ------------------------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M - Revised 1.57 F-P.CO.