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APPLICATION FOR SANITATION PERMIT Permit No. -__---.------'Z4-- (Complete in Duplicate) �Z /I1 Date Issued _-_-__�I___Gz_G___ 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 complianiie with County Ordinanc o. 549. JOB ADDRESS AND LOCATION >f ------ --- ------- - - =--------------------------------------------------------------- Owners Na -- f -- --- ---- ---- - - ------------ ---------------------- Phoe--- ------------------.-.-�-- Address____-- Contractor's Name � -------- --------------------------- Phone----,, -i will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I .❑ Other ❑ I� Number of living units: -I----- Number of bedrooms_.�l Number of baths -_ — of size ---_ 'IC I Water Supply: Public system ❑ Community system jW Private -Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA- Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well ---- _- tante from foundon.___' ---- _.-------Ma riaL____�►-'�_______--ff----- ---- No. of compartments-_ _ -______________Sizer __/Q__c __at• Liquid depth_,__ ----------------Capacity---- 1 ____ Dispos l Field: Distance from neare t well__ Distance of each I n ation /0�__- Distance nearest chlot line_ Number of lines-1 -' ,-- - ------- _ _ g 02 , 1 !_------ Type of filter material Length of filter material _-.--- .6--------Total length--_-I-----�---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------.....-___.Distance to nearest lot line----------------- El Number of pits-- ------------------Lining material------ --------------Size: Diameter---------_--------------Dept h_.-----------------------G------- i !� Cesspool: Distance from nearest well-------------__-Distance from foundation-------------------Lining material_..-------------------------'1_- ❑ Size: Diameter------------------------- ------Depth------------------------------------------------------Liquid Capacity---------------------------:igals, ^ � — _ - Privy Distance from nearest well-------------------____-------___.___-___----=Distance`from nearest building--_.-----____________--.-____ _ ------- Distance to nearest lot line 1 Remodeling and/or repairing (describe):---------------------•------------------------------------------------------------•---------------------------•------------------------------- `------- 1 11 ---------------------------•--•-------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------1-------- I ------------------------ ------------------------------------ ----=-------------------------------------•------------------ ------------------------------------------------------------- -----•------------------- ----------------------------------------------•-------------------------------------------------- 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 pegulations of the San Joaquin Local Health District. (Signed)4------ - ---- -------------------------------- --------------------------------------------------------------(Owner and/or Contrahctor) By:---------.......... ---{ 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 IE .I APPLICATION ACCEPTED BY-------• '-------------- ------------------------------------------------------------- DATE--------------------------------- REVIEWED ---------- ----------------REVIEWED BY---------------------------------------------- ------------------------------------------------------------------------------- DATE-------- ,.� BUILDING PERMIT ISSUED------------------------------------------------------ - - - DATE-- ----------------------- - --------------------------- �. Alterations and/or recommendations-------------------------------- -- --------._...--------------------------------------------------------•-•---------------- ---------- k --------------------------------------------------------------- -----•----------------------------------------------------------------------------------------------------------------------------------------------- ------- l ------------------------------------- ------------------------ --- - ------------------------------------------------------------------------------- I------ ! FINAL INSPECTION BY---------------- ---------- Date------------------•[ J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Street 814 North "C" Street III Stockton, California I Lodi, California Manteca, California Tracy, California f I ES-9-2M . Revises 1.57 F.P.CO. ° l