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F.� ! APPLICATION FOR SANITATION PERMIT Permit No. S--. (Complete in Duplicate) — Qate Issued Application is he-reby 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 Ordinance No. 549. 0 I JOB ADDRESS AND LtOn'CATIO'N� - �----- ld � Owner's Name-------------- - (fes -- •------------------------------------------------------------------- Phone--•-----------------•---------- Address---------.5-4 7 �------ -----------------•-------------------------------------------------------------------_----•-------------------- ------------- Phone----------------------------------- Installation Name---- -- ------ --• ---- -- -- - ---- --- -�-'��,,,,,------------------------------------ Installation will serve: Residence [,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherE Number of living units: _-�/-- Number of bedrooms _f__-_ Number of baths .f--- Lot size _- �_---_�--.71.5------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1-,Cl_ ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Kl�_ New Construction: Yes kq No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: 'stance from nearest well---------------- Distance from foundation------------ ------Material--------___-----------.------_-_------_----.----. ❑ f compartments--------------------------Size------•---------------------:---Liquid depth-------------------------Capacity--------------`----- Disposal Field: Distance from nearest well...-----_.Distance from foundation-__ e�--- --.Distance to nearest lot line--, _-..-.-- 54. Number of lines----------_y_` --_Length of each ---Width of trench-_-.---r�---------------- Type of filter material---'=37_._-__5�Depth of filter material------- Total length_---.----9f�__--------------------- Seepage Pit: Distance to nearest well------------- -----Distance from foundation--------------------Distance to nearest lot line-----------.----_ ❑ Number of pits-----------------------Lining 'Material-----------------------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: Distance,from nearest well-----------------Distance from foundation--------------------Lining material--------------------.---------__--_.- v ❑ Size: Diameter------- -- ------------- ---- ------Depth----------------------------------------------------Liquid Capacity------ ----gals. -__-____.-.-Distance from nearest buildin Privy: Distance from nearest well---------- -s--------------- - g----------"-" -------------------------- (�, ❑ Distance to nearest lot'Iine--------------------------------------------------------------------- – Remodelingand/or repairing (describe)-------- --------------------•----------------------------------------------------------------••-------------------------------------------. ------------- --------------------------------------•------------------------.-.._-----------------------------------------------------•----------------------- '1 -------- --- ----------- -------------- ------"--------••--------------1-------------------------------------------------------••----------------------------------_...------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. r .. ----------- --------------------- -----------------------------------(Owner and/or Contractor) (Title) gY-t (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 I APPLICATION ACCEPTED BY DATE------ —---------------------------------------------- REVIEWEDBY---------------------------------------------- - DATE" BUILDING PERMIT ISSUED ----------- DATE ------------------ - -- - Alterations avid/or recommendations----------------- -------- - ------------------ ' ` �-_ \1 -------------------------------•- -----------------••----------------------•------ -------------------------------- -------- -------------------•---------------------------------------------------------------------------------:-------------------------------- --------------------------------------------------------------------------- `3 -------------------•------ - `3-- r + FINALINSPECTION 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 Revises 1,57 FP-CO.