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APP,LICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued j_;��fhy. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549. i;�------- - ------- --- JOB ADDRESS AND _�TION_ r -- -- ----- ---- --- --------------- --- ---- - -------------------------------------- ---- Owner's Name------- - ......... - Phone------------------------------------ �Za G '7------- ------------------------------ --------------------1!--------------------------------------------------------------------------Address------ ---------------------- Contractor's Name---------------------------------------------------------------------------- - ----------------------.------------------ Phone..--------------------------------- Installation will serve: Residence K Apartment House E] Commercial E] Trailer Court [] Motel [] Other ❑ Number of living units: Number of bedrooms _1-____ Number of bat's -r--/r-- Lot sizeX-,ao go -------------------------------- Water Supply: Public system E)Y- Community system C] private F1 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam [:1 Clay El Adobe ] Hardpan ❑ Previous Application Made: Yes E] No New Construction: YesRL_No Ej FHA/VA. Yes D No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if public s9wer is available within 200 feet.)— Se tic Tank: Distance from nearest v AWNDisfance from foundation---/b-------i...K4aferial---&Z No. of compartments---- ---------------------- Liquid depth---- -----------Capacity-- OM,f Disposal Field: Distance from noere weft �_ _.D�stancle+� OU'riclati8ri-o7d d___:------:Disfance to nearest lot line__ ------------ __4 4�e ......j - Width of trench.... V---------------------- Number of lines Length of each line--, Type of filter mate ----Depth of filter material-/,7--e0_L_v-_4.TotaI length---____ (________________________el rial Seepage Pit: Distance to nearest well----------------------Distan'ce from foundation-------------L_Distance to nearest lot line_________________ ,j ❑ ine------------------ El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h- ---- -------------------------- Cesspool: Distance from nearest well-----------------Distance f-rom$foN nd,ation-------------11- --1ining material------_________.___________._____-__. --- ESize: Diameter - -- ------- - Depth _� 1 - Liquid Capacity -gals. Privy: Distance from nearest well___________________________________________ Distance fromnearest building._____.._--------------_______.__________-- ElDistance to nearest lot fine-----------------------------------------------------------------------I-------------------------------------------------------------------- Remodelingand/or/or repairing (dJscribe):------------------------------------------------------------------------------------------------ ------------------------------------------------------- ----------------------------------------I----------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------- �} ---------------------_------------------------------------I----------------------------------------------------------------------------L------ -------- ----------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------7-------------------f------------------------------------------------------------------------ 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 San Joaquin Local Health District. (Signed)------ ------- -- -- - ------------- -- `rV - -- -------------- -------------------------------------------------------------------(Owner and/or Contractor) . --- ----------------- ----------------------------- ------------- ------------(Title)----------------------------------------- ----------- I (Plot -----------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYA(V,61 CeA0)i -------------- DATE__aI WC-;/ REVIEWEDBY---------------------------------------------- ----------------------------- ----------- ------------------------- DATE---------- ---------------------------------------------- BUILDING ---------------------------------------------BUILDING PERMIT I S SUED - 4- --- - L -- - -D-ATE Alterations and/"r r commendation - g - - ----- ------ -----------------\-----�-- ......... , ---------------- - - ------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- 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 - Revisea 1.57 FP.CO.