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APPLICATION FOR SANITATION PERMIT Permit No, (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. JOBADDRESS AND LOCTION---- - --------------------------------------------------------------------------------------------------------------------------------------------- Owner's Name----- ------------------_ Phone Address---------- A::Fo Y_ ------------------k:�� Contractor's Name____,4 _,"ZZ..... ------ --------------------------------------------------- Phone Installation will serve: Residence FXJ Apartment House El Commercial RI Trailer Court E] Motel E] Other Number of living units: Number of bedrooms ❑ Number ❑ of baths 'I,-- Lot size xio Water Supply: Public systemX Community system E] Private E] Depth to Water Table -------- ff. Character of soil to a depth of 3 feet: Sand N Gravel [] Sandy Loam El Clay Loam E] Clay 0 Adobe [] Hardpan Cj Previous Application Made: Yes Ej No IX Now Construction: Yes 50 No El FHA/VA: Yes F1 No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well--/*-"---_Distance from foundation----Yll�- Maferl al---4�� IN No. of compartments---- j-1 ------- ----------------- Disposal Field: /4 d-V ----------Size----a- _CY -PV Liquid clep:th-----6-0----- ---------Capacity---------------------------- Distance from nearest well-jo-1 ---!-Distance from foundation--- ------------Distance to nearest to line-.-C' x Number of lines-------13------ ---Length of each lineA -Width of trenc�_AK� ------ Type of filter materia/ ---Depth of filter materialAP-6 ---------- Seepage Pit: Distance to nearest well----------------------Distance from foundation__. jotal lengfh/46 ----------------------------- on--------------------Distance to nearest lot line_ 0 Number Of pits----------------------Lining material----------------------_S;ze: Diameter-----------_-----------.Depth- ---- --: --------------- Cesspool: Distance from nearest well-----------------Distance from foundation-,-_.--------------Lining material__-._---------------------------------------- F1 Size. Diameter--------------------------------------Depth---------------- -----------------------------------Liquid Capacity-------- --------------- rn Privy: Distance from nearest well------------------; I ---------------------gals. ----------------------------Distance from nearest building-- ------ El Distance to nearest.lot line-.._"--___.-__-- --- -- ----- -------------- ------ -------�------- -------------------�M------- Remodeling and' ---------- /or repairing (describe): ------------------ ----------------------------------------------------------------------------I-------------------------------------------------------- ----------------- ---------- ---------------------------------------------- ---------------------------------- ----------------------------------------------------------------I---------------------------I------------------------------------------------------- ----------------------------- -- ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------- -------------- I hereby certify that I have prep6red this application and that the work will be done in accordance with San Joaquin---County ordinances, St laws, and r s a cl-�ula+ions of the San Joaquin Local Health District. (Signed)------------------ ---• -- ----- ------ -- --------- ------------------------ - ------------------------------------------------------------------(Owner and/or Contractor) Sy:----------- _---------------------------------------------------- ----------------------------------(Title)--------------- ---------------------- (Plot plan, showing size of lot, location of system in---relation--fo'-wells, buildings, etc., can be placed an reverse side). --------------FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- . _J7 &---------------------------------------------------------------- DATE-- REVIEWED BY ------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE-------------------------------------------•,-----. ATE-------------------------------------------- .............. -------------------------------------------------------------------------------------- DATE Alterations and/or recommendations -------------------------------------- --------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ---------------------------------------------------------------- ------------------------------------------------------------------- -------------------------_---------------------------- FINAL INSPECTION BY;,x- 4 ?-/P --------------------------- Date-,- -------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cafifornia Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.RICO.