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1 5 APPLICATION FOR SANITATION PERMIT Permit No. __ _j__ (Complete in Duplicate( ___l1 fl Date Issued . ,7_/S_?_ 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 Or No 549. JOBADDRESS AND LOCATE N------.. --- - ---------------------------------------------------------------------------------------------------------- Owner's NL4a!�� --- ------- - ---------•--------------------------------------------------------------- ----- Phone-_-------------------------------- Address---- -- - --- -------- Contractor's Name ------------------------------------------------------------ Phon ------- - Installation will serve: Residencel7 [y�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!__ Number of bedrooms oZ_ Number of baths -_R9- Lot size __� _� _ -___-------------- Water Supply: Public system [L}--c-ommunity system ❑ Private B-t-epth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B—Flardpan ❑ Previous Application Made: Yes ❑ No Ej--�New Construction: Yes LS N' ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r � Sep�t�icc nk: Distance from nearest well__ _-_____Distance from foundation___4 _.______-Material-__e_�� _ LJ - - - ----------'-'---5--------' No. of compartments P -- --�`-- ---:--- Size depth------�l7r CapacitY•----��-� - Dispasal field: Distance from nearest well Distance from foundation---Zo--------.Distance to nearest lot line.-------- Number of lines-------------------------- // Length of each line_____?_`----------------Width of trench------1.75 _----------------- Type of filter materiaLr',_6z_- .__Depth of filter material____-q_,r------Total length---------------------S` ._�_____-___ Seepage Pit: Distance to nearest welf---- --------------Distance from foundation-------------._.__-.Distance to nearest lot line_______-_-------- ❑ Number of pits----------------------Lining material---------------_-------Size: Diameter------------------- ---Depth-----------------------------____ \1\l Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- ________--_-___ \ ❑ Size: Diameter------------------------ -- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest welt-------_-----------------------------------------Distance from nearest building-________-__________-__________-_______- ❑ Distance to nearest lot line---------- --------------------------- Remodeling and/or repairing (describe}---- ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------qfafe ------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ I herehat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, , and rules and re ulations of the San Joaquin Local Health District. _____Owner and/or Contractor) (Signed)----- ----------------r----- -------- ----------- -- ------=---- ----------------------------------------------- -- 0 13y.__... -•------ .------ -------------------------(Title)--- (Plot plan, showing size of lot, location of system in relation t'o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- DATE------- -------------------- REVIEWED BY ----------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------.------___---------------------------------- DATE Altera i ns a dor recommendations___________________ ______ _-------_-_ -1 -�' carr-------- c - u.�. ,r, `� ----- - -------------- -cue ------------------------------------- -------------------------------------------------------- ------------------- ----------------------------==----------=----- FINAL INSPECTION BY:_- q'i - ?2 Date----- � r 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. j