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f w APPLICATION FOR SANITATION PERMIT Permit No. .__� . I E (Complete in Duplicate) / fn ; �/�� ..� Date Issued ___.3 : 1-,7/ C i 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 County PrdinpanFe No. 549. JOB ADDRESS AND AT10N-------- -------------- _ Owner's Name-------- P I - �--- - --- ----. ----------------------------------- --- hone---Address--- ----- � --- ----`---------------------------------------------------------------------------- Contractor's Name---- - - -- ------------------------------------------------------ Phone ---------------------- ------- ---------------- `I;Installafion will serve: Resid e Apartment douse ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other L] r Number of living units:.)_-_-_ Number of bedrooms _01� Number of baths ___.l___ Lot 1 size ------- ---70 - ------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 11-tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa Clay ❑ Ado ❑ Hardpan ❑ 'Previous Application Made: Yes ❑ No New Construction: Yes No FHAYes No iTYPE OF INSTALLATION AND SPECIFICATIONS: `` (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) �SepFic ar:k" Distance from nearest well: is an from foundation ___ ________ a erial____.__________-_----------------- , No. of compartments__---- ______=5ize__''`�__--___ Liquid—depth'----------- 'Capacity--------- ----------------- -------------- is `-- -' l isposal Fiel Distance from nearest well._-__Distance from foundatio ___._ Distance to nearest lot lir ----------- Number of lines -- _ ___-__ �j Length of each fine_______-_ idth of trench_ __ �,+ Type of filter material___'r/&' Depfh of filter material____._ ---Total length____._ �_______________ 'Seepage Pit: Distance to nearest wef!----------------------Distance from foundation___-_-_ __, --- istance to nearest lot line__-__..__-._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______--__.-_______________________ Is�,. ❑ 5ize:.,Qiameter --- ------------------------ Depth_.-=- ----------------------------------- -!quid Capacity.----------------,- gals. ,Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.----------------------------------- El _____--_-----_-- ❑ Distance to nearest lot line--------------------I------------------- -- ---_ "Remodeling and/or repairing (describe):---- --------------------------- ---•---------•----------------------------------------•----------------------------------------------- ---------------- ------------------------ I --- ------ - --- ----- -------- --------- f - - ------------------ -- --------------------- ------------------------------------------- I hereby certify that I have prepared this application and that the wo will be done in accordance with San Joaquin County (ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. EI (Signed)-------------------------------------------------- --- ------------- ------ ------------------- - -- T Q 9 •�'' �p�.. --.-- ---_____________________(Owner and/or Contractor) BY: •P - l �►_ - r-'' ------(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_w i APPLICATION ACCEPTED BY---------- ------------------------------------------- DATE - ----------------- -- -- REVIEWED BY------------------------------------------- ------------------- - DATE----------- - --------- BUILDING PERMIT ISSUED------------- ---- y� DATE----------- Alterations and/or recommendations_________________________._.__ _ ----------------•------•----------------------- ----------------------------------------------------------------------------•----•------- k - 1 'k .I FINAL INSPECTION BY:. Date_ ------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT A 130 South American Street 300 West Oak Street 132 Sycamore Stree! 814 North "C" S+tee+ 1 Stockton, California Lodi, California Manfeca, California Tracy, California I ES-9-2M . Revised 1-57 F_P.CO.