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Z n . *�#- ? ) APPLICATION FOR SANITATION PERM T4� Permit No. ._ G 3 (Complete in Duplicate) / Date Issued Application is hereby made to the San Joaquin Local Health District for a per o construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 1 -- . - V Owner's Name. -------- - - €- -------------------------------- Phone Address-------------------------------- -- - Contractor's Name---------------- -•---- ---- -7--1-----�" --- ----�---------------------------------------------------------•------•---- Phone----------------------------------- Installation will serve: Residence EXApaifinent House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../_. Number of bedrooms -------- Number of baths -------- Lot size .....:.........................._.._-_.__...._:---------- Water Supply: 'Public system JK_ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobo,'gy Hardpan Ej Previous Application Made: Yes„R No ❑ New Construction: Yes 2. No ❑ FHA/VA: Yes 1g No ❑ p a 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. .��-.____-.Mate iaL.............1.-- - �� F , �y No.. of compartments Size --- - cl I? --------_CapacitY V----- ___Li uid de th................ Disposal Field:_ Distance from nearest well._._-______A...-.Distance from foundation---_--____.-_------Distance to nearest lot line................. /_�/ Number of lines,----------------------------------Length of each line------------------------------Width of trench----------------------------------- i Type of.filter mate.riaL_----------------------Depth of filter material----------------.------Total length--------_------.-------._--_---------..... Seepage Pit: Distance to nearest well--------------------- Distance from .foundation............._-.....Distance to nearest lot line._...--.- Number of I pits----------------------Lining ..-_-- � material ------------Size: Diameter--=---------------------Depth----------- ---------------- Cesspool. Distance from nearest well-----------------Distance from foundation_.__..____..__.._..Lining materia l------------------- El .....--.---__-.... ❑ Size: Diameter_--==- - --------;.Dept h-------------------- -:-------- ----=------------Li Liquid Capacity= ....-.-..-.--_.-.-.g..e_.l.s... Privy: Distance from nearest well--------------------------------_--------------..Distance'from nearest building.____-.-_._..-..._--_...__.------._-__. ❑ Distance to.nearest lot-line---___--------- -: - ___ - - - ----------------I------- ------------------------------- ----------------------------- Re eiing an /or re airing (describe --------�------------------- ----------------------- - •� - m ��"+� � JJ -- ------- - Z4,40or -- --- ---------1.1...-- -- -- -- ---- - ------------- --- -- 1 _ - ------ ------------------ - --.`--.._ --------- ----------------------------------------------------- I ---------------------------_.---- i I hereby certify that I-have prepared this application and that the work will be done in ordance with San Joaquin County a ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. a d r (Signe } - -} - --- --- •- ------ --- --- --- --- ---------- - ----------------------------- - -- ------------------- -------{Owner and/or Contract ------Title (Piot 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----- ' f BUILDING PERMIT ISSUED--------------------------------------- -------------------------------------------------------------- DATE Alt r ti ns /regmendation :---- p --- •------------------------------------------• ..-.-_-----=------------------------•----------- --= -----•---- --------- 4/----- �- -mac - ----------------- - - --- - -------------------- - F FINAL INSPECTION BY------------------ -------------------- - -------- ------ Date.--------------------- SAN ------ ----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-9-21x1 . Revised 1.57 F.P.CO.