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APPLICATION `FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued ____/_. 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._ JOB ADDRESS AND LOCA 10 ___________ - o - --------- - -- Owner's Name______ _ __ k ----------------- Phone: ---V. Address-------------------------- Contractor's Name------------------------------------------------------------------------------------ ------------- Phone----------- Installation will serve. Residence X,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -,:?-- Number of baths -------- Lot size j37,?_,,Y_-/_"/_.1!r Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 3,.S ft Character of soil to a depth of 3 feet: Sand ❑ Gravel 0% Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No)< New Construction: Yes K N o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seweriis available within 200 feet.) Septic Tank: Distance from nearest well__"~_�__ Distance from oundation___ ff " ,f f--0-•------.Mat Material ------- ----- - ------•------ -------- No. of compartments--------_- ____-_-Size----. _ 1i uid depth----_ __ -Capacity. Q9 Disposa Field: Distance from nearest well. =,-----Distance from foundation__, _ _ ______.Distance to nearest lot line_[ L ] Number of lines___ _ -. • Length of each line-----c3_ - --------- Width of french---p Type of filter material____ ......Depth of filter material___ __ Total length_____�-21--Q"-------------__-- - .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-----------------D`stance from foundation--------------------Lining material------------------------------------ ❑ Size: Diameter------------------------- r- --------Depth----------------------------------------------------Liquid Capacity----------------------------gals. �. r _ 1 Privy: Distance from nearest well:__ )_----------_ -------L---------------- Distance from nearest building ---- ❑ Distance to nearest lot line _______---_•_---__-__--.------_" Remod ling and/or repairing,(describe):_____-_ ; a - --- ----- 4,------- a I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and-rules and regulations of foe San Joaquin Local Health District. {Si ned --- 9 ]- �^� -- - -- ..�...--- ----------- ------ ------------ ---------------- --- - ------------(Owner and/or Contractor) --------------- By:_------------------------ �) s Tltle ---------------------------------- ---- --------• ------------------------------------- ------ - - - (Title) •------ - - - - - ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). .a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- --------- ---------------------------- - --- ---- •------- -- ---------- ---.- DATE-- .. -- -- ----------- ----- REVIEWED BY.-----------•--------•-------------------- - �- ----------- - -- -- DATE------------- ---"•--"•--� " - BUILDING PERMIT ISSUED---------------------- ---- - -- -- -----------------—------ ------------ -------. DATE aerations and/or recommendations:______-_ ---------- ---------- ----------------------------------•---------------------•- �_ --------------------------------------------- FINAL INSPECTION BY:.____ �- ---------------------- ------------•-------- ------- Date,.w.;- -------------- -------------•- -- 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.