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4° APPLICATION -FOR SANITATION PERMIT Permit No. .. ._.._// ___ (Complete in Duplicate) Data 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 Countyrdina No. 549. JOB ADDRESS AND LOCATION._ ___. _ /�- - ------------------- ------- ------------- ;� Q----------- Owner's Name ---------- /I�-----------------------------------=---------------------------- - --- -------- Phone_ ----------------- --- !__��f-_ Address. - ---- ------------- --------------------------------------------------------------- --------------------•-- ---------------- Contractor's Name -- -----` -------------------------------------------------------------------- Phone- . 1 Installation will serve: Residence Hi---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms a2 `� � ao - t1 ----- Number of baths _�--- Lot size ----------- - --------------------------------------- ---- Water Supply: 'Public system R_--c"ommuriity system ❑ Private ❑ Depth to Water Table 47_9 ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam E] Clay ❑ Adobe Et�Hardpan ❑ ` Previous Application Made: Yes El No E. New Construction: Yes ❑ No Ej-___FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4,p,, apk: Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------------- No. __.________________________________._._-_ No. of compartments-------------------- ---Size--------------------------------Liquid depth--------------------------Capacity---------------------•- eld: Distance from nearest well------------------Distance from foundation___________ Distance to nearest lot line----------------- d. of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material____.____//___-_-______Total length------------------------------------------- Seepage it: Distance to nearest well -sW_ Distance from founP.D_ dation____ Z---._Distance to nearest lot nL- Number of pifs....__-�-------- Lining material __ .__ _-Size: Diarreter____3s _____.Depth-- c _s�____________ _ 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 lire------------------------------------------------------------------------•--------------------------------------------------------------------- Remodeling and/or repairing (describe)=------------ ----------------------------------------•----•---------------------------------------- -••-------•---------------•------------------------- ------------------------------------------- ----..---- -------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------••-----------------------------------•----------------------------------------------------------------------••----------------------------------------------------------- I ----------- ------- - ----- I hereby ce if that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a ws, and rule and regulations of the San Joaquin Local Health District. e (Signed)------------ ---------------------------wt (Owner and/or Contractor) ------- - --- -----------"-- ---- --- ---- -------By:---------------------------------------------------------- -------------------------------------- .-•-------------------------(Title)-- ---------------------------------------------(Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- DATE � REVIEWEDBY---------------------------------------------------- ---�------,------- -------------------- DATE---- --•---`--- BUILDING PERMIT ISSUED----------------------------------- ------- DATE.----------- -------_ Alterations and/or recommendations------------------------�------------------------------------------------------- s_ f �^-------------------------------------------------------------------------------------------------------------------------------- _ ------------4__._ __ rte,_ .............. ------------------- 7- t-�----- ------ --J0-- ! n- ----------------------------------------- - - -- - ------------------------------------------------------------------ -------------------- 1"_.-- A------ ------ FINAL INSPECTIONBY:: � Date_.. j �: 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 E5-9-2M Revises 1.57 F.P.CO.