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APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Duplicate} Date Issued ' This Permit Expires 1 Year From 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 i�h Co ty rdinapj? No.-549. 6pa �a, � 1� c (/ r -, _ - ` � JOB ADDRESS AND OCATION___- _________ _____�--- -f1 -�" ---- 4 O Owner's Name----------- � __. --------------------------------- Phon ----- - - - -----.. Address-------------6.01------I--------------- ------ ..-------------------•- --------t------------------�-----------......GN � 1 .... a IContractor's Name----Installation will serve: Residence Ap tment House ❑ Commercial ❑ TraiCourt �] M-6fel'❑ Other ❑ f Number of living units: _-j___='Number of bedrooms -- Number of baths _�e Lot size 'Depth ' �•to Water Table I6v- ft. r Water Supply: Public system El Community system E] Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam C1ay.Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ fl Previous Application Made: Yes ❑ No W New Construction: Yes ❑ No FHA//VA: Yds No El TYPE OF INSTALLATION AND SPECIFICATIONS: t- (J.� (No septic tank or cesspool permitted if public sower is available within 200.feet.) Septic Tank: Distance from nearest well__�OQ-_/__Dista ceifr m foundatpn___,j(}__--__---Material__..__ __.______ No. of compartments_-_-_ ------------ . - �_X_q_ _Liquid depth----- .Ca acit Zpd Dispo al Field: . Distance frbm'nearest well---,�UD____Distance from foundation. _ ____Distance to nearest lot I�e_______...__.___a Number of lines---.-_-----�.-------- Length5-of each line------ --ff------Width of trench-____.% ___--- ___________ ; r Type of filter material____, _Depth of filter material--__.-/�_----_.-.._Total'.length________ rOp_--------------------- _. Seepage Pit,: - Distance to nearest well----------------------Distance from foundation------------ .------- Distance to nearest lot line----------------- . Number of pits----------------------Lining material------------------------Size: Diameter------------------------Dept h--------------------------------- esspool: I Distance from nearest well-----------------Distance' from foundation--------------------Lining material--_._-_-.-__----_.-_____.__--______- Size: Diameter--------- ----------------------- Depth----------------------------------------------------Liquid Capacity--------------------------- gals. Privy- Distance from nearest well _____________________________________________---Distance from nearest building---------------------------- ---------I -. [� Distance to nearest lot line-------------------------------------------- ------------------ ------ ----------------------------------------------------------------�--- Remodeling and/or repairing (describe)---------- ? --- --------------- --------------------- ------------------------------------------------------------------------------- ---------------------------------------------- --------- ---------- ------ -- -- ------ ------------------------------------------------- ------------------------•--------------------------. ----------------- --- ------------------------------------------------- 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 law , and rules and regulati of the San Joaquin Local Health District. ---------------- ------------------ - ---- F Contractor) (Signed}---------- - -- -- --- - ------ - ---�------ - ----- ---- ----- -- ------ - -- By------------- -------------------------- •--------------- ---- --------------------------------------------------------------(Title)------------------------------------1-- ------------ -- - (Plot plan, showing size of lot, location of system stem in relation to wells, buildings. etc., can be laced on reverse side. FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY-- '--"� ------------------- = ' -'-----------"-- --------- DATE_ - - ----- REVIEWEDBY---------------------------------------------------- ---- ------------------------------------------------ ----------------- DATE------------------------------------ =--------------------- BUILDINGPERMIT ISSUED------------•--•------------------------------------------------------------------------------------ DA•TE------------------------------ ----- Alterationsand/or recommendations:--------------------------------- ------.:------------------------------------------------------------------------------------------------,----------------- ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------•------ i --- ----------------------------------------------------------------- ------------------------------------------------ ---- ---------------------------------- --------------------- -------------------------- --- --- --------------------- ------------- - 0_6 FINAL INSPECTION BY: �,, --------------- Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street t 132 Sycamore Street 814 North "C" Street CaliforniaManteca,CaliforniaTracy, California Stockton, California Lodi, £S-9-2M Revised 8-'59 F.P.Co.