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. . — — , APPLICATION FOR SANITATION PERMIT Permit No. _ .2►- 3,- ' (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 ANQOCJTION__.____- -. --_QJ Owner's Name ` ,r /---� �------- --- 1--- ------- --- Address --- ' - - ------- ----- Phone----- ,�..'�---=-------- •-- •-- --------------------- Contractor's Nam -- --.--_ ' �" --------- - -- f +� -•---- Phone.. . �f Installation will serve: Residence partment House ❑ Commercial ❑ Trader Court ❑ Motel ❑ Other ❑ Number of living units: ___)___ Number of bedrooms _Number of baths Lot size Water Supply: Public system Kcommunify system ❑ Private ❑ Depth to Water Table-?-9ft. Character of soil to a depth of 3 ,,f//e��et: Sand El Gravel ❑ Sandy Loam El Clay Loam ❑ Clay El Adobe �ardpan ❑ Previous Application Made: Yes .f'o El New Construction: Yes ❑ No [-] FHA/VA: Yes ❑ No E]TYPE OF INSTALLATION AND�#SPE\CIFICATIONS:- (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Seepos,l' tic ank: Distance from nearest well_ rM,! Distance from foundation-____ / a-------..Material------ ---- No. of compartments-----_I`------------Size_----�-4_--._ Li uid depth _ q p -- -- --------Capacity-•- - - / ,,��►► line- Number D �Fi -., Distance from nearest weff_________________Dista�ce�rom foundation.______.__.____.___.Distance to nearest lot ________________ of lines----------------------------- -----Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material________________________Depth of filter material-----------------------TotaJ length_______.._______-_____.- -� epage Pit: Distance to nearest well-----------------------Distance from foundation--------------------_Distance to nearest lot Number of Pits----------------------Lining material----------------------.Size: Diameter------------------- --Depth--------------------------------- Cesspool: N Distance from nearest well-________________Distance from foundation----------------.___.Lining material ___.___._____._._-__-__________ ❑ Size: Diameter------ -----=----------- -- ----------Depth------------ -------- --- - --------- - ---------Liquid Capacity- ---- ---------- --------9als.� Privy: Distance from nearest well--------------------------------------- from nearest building g ❑ Distance to nearest !ot line----- --- ---------------- 00, Remodeling enc{/or repairin -{d�scri e):___-__ _ ------ ,f -------------- J r ---------------------------•-------- --------------- 10 _____________ / -�_l__{__� __._ -_ _r_ _y-__________-_ I hereby certify that I have prepared this applica ton and that the work will be done in accordance with San Joaquin County ordinances, State laws, and`ruulessaa d regulations of the eSSan Joaquin Local Health District. (Signed)_ r Y` ! _ ---------------------- -Contractor) By:------------------------------------------------------------------ �` - ---(Title) - - --- ------------------ -------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to we) , buifdings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY * • DATE APPLICATION ACCEPTED BY---------------- ------------- ------------- -------------------------- -------�------ _ --------------- REVIEWED BY ------------------------ - ----- --------------- DATE------------ BUILDING PERMIT ISSUED-----•----------------------------- -- -- � � �- ---------------------- ------- Alterations and/or recommendations:__----------------------- ------ DATE--------------ta - ---------•------------ ----------- -• 'n• k ---•---------- 't\ -------- -----------------------------------•----------•---------•----•-----•----------------------------------- h ------------- -------------------------------------------- --------- - -- FINAL INSPECTION BY--------- - --1------------ -------------- - -- -------------- ----------- -------------- ��-��-i��.--------- ---------• •----•---- ----- 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 F.P.CD. ?