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APPLICATION FOR SANITATION PERMIT Permit No. /Q.?>v II' (Complete in�Duplicate) S� Date issued Application is hereby made to the San Joaquin Local Health Districf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----_ -_-- _ 7 _ � --- -- --- ------------------------------------ r e Owner's Name r �� ---- -------------- ----- ----------------------- -- -- Phone--------------------•-----------•--- Address---•------••--------------- . �� . �f_ � ------- `,f--------------------------------•--{. ..r -------------------------------------------------- Contractor's ------------- ---------••------------•---•--•---- Contractor s Name - - ePhone. - ---------------------- --- Installation will serve: Residence [A,—Ap—artment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _ _ Number of baths __/__ Lot size _____ 47--- - s----------------------- Water Supply: Public system ®'Community system ❑ Private ❑� Depth to Water Talile _______ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam"❑ Clay Loam ❑� Clay ❑ Adobe Hardpan ❑ Previous Application-Made:--Yes ❑ -No r[��IVew Construction: Yes ❑ No..[Z—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: rr (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) } Septic Tank: f Distance from nearest welt_________________Distance from foundation)Md _=.Material3:_-____-_-_---_--__--.--__-__--__--_._.._._.._.. ❑ No. of compartments----------- --------�---Size------------------------------�-L�quepth � Capacity Disposal Field: Distance from nearest well-----4r'------.-_Distance from foundation------jr_----._.Distance to nearest lot iine_ ,C7-_-- �umher of lines________________ - Length of hl3;-�Width of trench_____ _ Oel_--_---_-----._ pe of filter material---_- repthoffItermaterial_.___le_'----� Total length------?'1::n_`------------------------ Seepage Pit: Distance to nearest well---------- ----------Distance from foundation--------------------Distance to nearest lot line----_-------_-_._D TIN Cl P ------•---------------Lining material------------------ Size:'I3iameter•-------------------Depth----------•---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material--------__--_.____.__.._____-.-___-. ` _-_-_-_--.-_Liquid Capacity-❑ Size: Diameter---------------- � _Depihk ----= - -- -- - - q p Y- -- -- -- -------gals. Privy: Distance from nearest well------------t-------- -------- ----------Distance from nearest building_------______________________.._____- ❑ Distance to nearest lot line-------' -----------------------•----------------------------------- --------------= --------------------------------------------- Remodeling and/or repairing (describe):__________________________ [ ------- ---------------------------------------- = - ----- f '\ ----------------------------------------------•-------------------------------------------------------=--------------------------------•--•-------------•--•---------------------------------------•------------- I hereby certify that I have prepared this application and thaf,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. Owner and or Contractor (Signed)_-----�- ------ 1✓ : y - - _--:- _:::_:. = �I / 1 By:--------•------------------------------------------------------------------------------------------- ---------- --------------------(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------- ----�J-=�-- - -- -- -, - ----------------•- REVIEWED BY------------------------------------- -------- ----- = DATE_ = BUILDING PERMIT ISSUED---------------- ------------ - !---------------- ------ DATE---------------------------------- --------------- -- Alterations and/or recommendations:-------------- -------------------- --- ----- ------------------------------------------------------•-----•----•-•----------------------------------------- -------------------------------•--------------------•------------------- -------------------------------------------------------------------•-------------------------------------------------------------------------------- ----------------------•------- ------ --•- -- ---- ---•----------•-----------------------------------------------------------•--------------------------------------- ____________________________________._-_---____-_-_ --.-__ ____-_.------..-.---4 . ---_ ---.---.----------------.-----------------------------------------------------------------------------------------...-_---_ Date :Y: I�FINAL INSPECT �---- ----- - --- --- SAN JOAQUIN'LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street` 132%camora Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 FY CO.