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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / S Date Issued S��i`-I.-�l. Application is hereby made to the San Joaquin Local Health District for a pArmif to construct and install the wok herein described. This application is made in compliance with�ountY O di ce No. 549. �#S'oS /4)CST �JOB ADDRESS A D LOCATION__ _ ia _ Owner's Name_ -_ ---- f r� p� ------------ -------- Address-----. - -• _ --------- == ontractor's Name----------------------•---------- -- - -----•-----------------------•---- ------- ----------------- -- --- - --- ------------------- - Phone-----•--•---------•-•-------------- Installation will serve: Residence Apartment Hous Commercial ❑ Trailer Court ❑ ote! y�}j ❑ Other ❑ Number of living units: ___t____ Number of bedroo '�' fit-- Number of baths __/____ Lot size _-____!' ---__- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _____ ft. Character of soil to a depth of 3 feet: Sano' Gravel ❑ Sandy Loam Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes �No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearest well------------------Distance from foundation Material No. of compartments----------------•,- /'��a-�-'---))Size-------•-------•---- -----------Liquinnd,depth- --------------------------Capacity-••--- ------r------r- f Dispo Fie d: Distance from nearest well _.I�-/N+�Distance from foundatior/il._. _ .Distance to nearest lot line_____1'�.hV �{- Number of lines---•------- -----_-----Length of each line----------- Width of FT Type of filter materia_ __ -14 `t trench'____"__ __ r - '1 th of filter material al length________,__}---_""-"--- (> eepage Pit: Distance to nearest well----------------------Distance from foundation--------------.._--.Distance to nearest lot ❑ Number of pits----------------------Lining ma#erial-----------------------Size: Diameter------•- --------•----Depth------------------- " ------------- d Cesspool: Distance from nearest well-----------------Distance from❑ foundation _ Lining material_________-______.------------------- V1 Size: Diameter -- -------Depth -_Lining material Capacity----------------------------gals. Privy: Distance from nearest well--------------__--------------------------------Distance from nearest❑ building Distance to nearest lot line._.__.__-_____.___ ------------------------------- 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 andre lations of the San Joaquin Local Health District, (Signed)__ . -------------------------------------------------- (Owner and/or Contractor) SY� ---------------- - Title ___ ------ ----------------------- ----------- - ------------------------------------------- (Plot plan, showing size of lot, location 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.---------- -- Alter do s a�rrecommendations-- --- - -- ------•----------------------------------- ft-------`!� ow--- lam- G------- --- 7 - -- ---- f�r-) - -•------------------------ FINAL INSPECTION BY:---------------------------------------------------------------- Date- 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.