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APPLICATION FOR SANITATION PERMIT Permit No. � a tt (Complete in Duplicate) // - Date Issued __v____4�_`_�__� 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 Ordinance No. 549. � . C ,,; � � JOB ADDRESS AND LOCATION----_--- �-_ �-----.---=�.•-----�(,--- ---- � -- ---- --------------------------------------------------------------- Owner's Name----------------( " Phone--===Q - Address-------------------------------------------•--, 33 =— • { � �, ------- ------- ----------•-----------------------------------------------------•---------------------... Contractors Name_______________________ ------- ----------------------------------------- ------:------------------------------------ Phone----------------------------------- 3 Installation will serve: Residence e-'-Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel f❑ Other 0 Number of living units: _�----- Number of bedrooms __3__ Number of baths _1____ Lot size ---1�~___P�____1__[/_ ____ ---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobei[ Hardpan ❑ t Previous Application Made: Yes ❑ No New Construction: Yes ®' No ❑ FHA/VA: Yes,❑ No 15 TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr wells/rc -___Distance from foundation___�C_____-__.Material___ L�+r4�Cj No. of compartments------- Size-__2I24_.,5Xx 1----,---Liquid depth,--_____-Y---------------Capacity...•___d_______..__ Disposal Field: Distance from nearest weO-XLX e�=.Distance from founclatiow_V-------------Distance to nearest lot line__-.---_-__. fl Number of lines_------ __.______-Length of each line__�` _-_:_�____�fi'__.Width of french---- ` -`'--------------------- ' Type of filter material___ �--------Depth of filter material_... "__.____'_Total length____Z_4Z_________________________ Seepage Pit: Distance to nearest well __-------------------Distance from,foundation------------------4Distance to nearest lot line-______._________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------.--------Depth------------ Distance from nearest well-----------------Distance from foundation--------------------Lining material___.____--______-_-.___-._____-----__ ❑ Size. Diameter----------------___----------- ----Depth-------------------------------------------------.-Liquid Capacity----------------------------gals. Q I Privy: Disfance from nearest well ________________________________Distance from nearest building------------------------------------------ El Distance to nearest lot line----------------------------- --------------------------------------------------------------- Remodeling and/or repairing (describe) - = -s �� _ -------------------- ----------------------•----------- -------- -------- --- •-------------------=---------------------------- --------------------------------------------•------------ -----------•---------------------------------------- ---------------------- --------------•-----------•-------- =-------------------------------------•-•-------------------------------------...._.-=----------------------------------_------------------------------- ------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------- -------- j 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 and regulations of the an Joaquin Local Health District. (Signed] >. '-'-------` d 9 ) '-!'if- -.W_ - ------------------------------------------------------------k c-----------------------(Owner and/or Contractor) By:------------------------------------------------------------------- ---------------------------------------------------------------{Title)------------------------------------------------------------ --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------------- ------- ------------ ------------- DATE-----t T-6F- �- _ __ ____________________________" REVIEWEDBY-------------------------------------------------------------------------------------------------------•-------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- DATE ------------------ Alterations and/or recommendations-------------------------------"------------------------------------- - ----------------=-----• .------------------------------------------------- ----------------------------------------------------•--------------------------------------------------------------------------------------------------------- ..-----------------------••-------------------------- t I -- ------------------------------------------------------------------------------- ----•----------------------------------------.------------------------------ ------------------•------------ ----- ---- - ---- �. FINAL INSPECTION BY: Date--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revisea 1-57 F-P.CO. I