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FOR OFFICE USE: _ .:_.�•Q APPLICATION FOR SANITATION PERMIT in Duplicate) ...__" (Complete P � bate Issued This Permit Expires 1 Year From Date Issue 02.5-1-710--30 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. '` F JOB ADDRESS AND .00TIOcN ' d� �� ... -------------- Phone------------------- --------- Owner's Name--- -------=-----•-- ------ - -- - Address------------------------------------------------------ ------------ - --------•--------------------------� - ------------------------------------ --------- '�c / e '.2'd � r '�R Phone_.. - Contractor's Name__ � -•--•- -.- -- -•- - - -� �--- -�-- - " -- - Installation will serve: ,Residence IM Apartment House ❑ Commercial E] Trailer Court El Motel [I Other [I :-_ Number of baths __ __ Lot size _--- ---- ---- "----------------- --•------- Number of living units: ________ Number of bedrooms _- Water Supply: Public system ❑ Community system ❑ Private JB Depth to Water Table _X.9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam k] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.:-"................) No [3 New Construction: Yes 50 No ❑ FHA/VA. Yes ❑ No ❑ t] �� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C Septic Tank: Distance from nearest well-47A-------Distanc�from foundation_L ------------ ._p Y U o No. of compartments. _Size_.- ;-t--- S---------Liquid depth_____a�----------------Ca acit _--�_"-------------- Q = ---- �, Disposal Field: Distance from nearest well ---------Distance from foundation__fp__-....._...,Distance to neares i t line-j-- ------"-- • .-- Len th of each line_-l'%�_ i •l PWidth of trent --- �---------------------- - Number of lines_____. __-------------------------- g Type of filter material" Depth of filter material ��---------------Total length___: ___.�R- -------------------- ►."r Seepage Pit: Distance to nearest we I_.__._.._`_:_____=__._Distance from foundation--------------------Distance to nearest of ine_..___._____.__._ ❑ ------ -----Depth--------- ----------------------- Number of pits______________________Lining materia!_______._._.-_-___.__.Size: Diameter Distance from nearest well--------------_-Distance from foundation--------------------Lining material-______________________________ al s.----- Size: Diameter--------------------------- ----------Depth----------------------------- ----------------------Liquid Capacity----------------------------g Privy: Distance from nearest well------"------------------- -----------------------Distance from nearest building------------------------------------- ---- ❑ -------------------------------- -- Distance to nearest lot line_____________________ -�-��--�-�- """"""�" Remodeling and/or repairing (describe):._"-- ------------------ --------- -----------------•---------------- --------------------•--•-----------------------•------------•------------------- ----------- ----------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------------------- 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. Si ned - o ct m (Signed) _ T.�� ner � and/or Cont or) ----- - --------------- (Title) (Plot plan, showing size of lot;location of'systeni in relation to wells; buildings, etc., can be placed-on on-reverse side). FOR DEPARTMENT USE ONLY cDATE_ r� Q�� --------------------------- APPLICATION ACCEPTED BY_ ' ' -------- DATE------------------------------------------------------ ----- BUILDING PERMIT ISSUED------------------------------- ---------------------- ------ ------ DATE------------------------------------------------------------ I Alterations and/or recommendations:---------------------- - ---- ---- ------------- -----------------"----------••-•- -------------------------------•--------------------------- ------------------------------------ ----- - - ------ r - - Date �3 INSPECTION BY- e"$ ---------- SAN -- JOAQUIN LOCAL HEALTH DISTRICT 16o1 E.Ha:ellon Ave. 300 west Oak Street 124 Sycamore Street 205 West 911h Street Lodi,California Manteca,California Tracy,California Stockton,California .� E5 9 REVISED 8-59 3M 3-'63 F.P.CO.