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��Vn c/ APPLICATION FOR SANITATION PERMIT Permit No. _ ............ (Complete in Duplicate) • Date issued .__/��-- Application',is hbreljy.made to the San Joaquin Local Health District for a permit to constr ct and ins all t r�ork herein described. This application is made in compliance with County Ordinance No. 549. 51_7 ,iE r c✓p JOB ADDRESS AND LOCTION-.- �� Q' '� •,T� '_�Q_ ,5_j��T '.�5 Owner's Name a. f_ - Phone- Address------------------------- hone_Address------------------------- ------ - --- ----- - - - ------ --------------------------------- Contractor`s Name______ ____- - .Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ______ Number of bedrooms Number of baths/_______ Lot size -_______ ____ ------------------------ , Water Supply: Public system.❑ Community system E] Private pth to ter Takt__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Cia Loam Clay Adobe Y Y ❑ Y ❑ ardpan ❑ Previous Application Made: Yes ❑ No EV<ew Construction: Yes to ❑ FHA/VA: Yes ❑ No [1__ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well-JO---J__ Distance.from foundation___,,1Q_--- --.Material__oCe.......6?--A i q �o p 4Q �1 No. of compartments__ -___ ______---__Size�6-,� ��_--4'Q._--Li wd dept - ------ _ -_-� Ca acitY---�' Disposal F Distance from nearest welt_ __p_C7--.---,Distance from foundatione-Ve _ ----------Distance to nearest lot line_- _d_J_•. �* j Number of lines-----------,1----------------- - Length of each line------- __f___-_-- Width of trench---------4 1� "Type of filter material � �oc_a1Depfh of filter material-- -_________ Total length___-____. j T 1 . Seepage Pit Distance to nearest well . . -----Distanceo 0rfoundation_.la,S_ _.Distance to nearest lot line_.3.0_�___ ❑� Number of pits--------1------------ g � ^� - Linin material_��,�____�.041gize: Diameter____J��---_-.-___Depth Q_b-_-------------------- - Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material----______________-----____________ Size: Diameter--------------------------------------Death---------------------•------------------------------Liquid Capacity----------------------------gals. 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. (Signed)-----•- �R` 10--� ---------------------------------(Owner and/or Contractor) BY ------------(Title)-----� -1---- ----- f. . -� (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ----------- - ------------------- ---------------------------------------- D�ATE ---- -- ------------------------ EVIEWED BY --- --------- ATE_ BUILDING PERMIT ISSUED__. ----- - -------- --------------------------------------------------------------- DATE. _!_ ---------------------------------------- Alterations and/or recommendations:_______..__ ---------- -------------------------------------- s 5 --------- �r - - 4 -- - ---- ---r,�. . r5 ------------------•------- -------------------------------- ---------------------------- FINAL INSPECTION BY:------ -- ---- '------------- --- Date-- ------ SAN ----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 , Revised 1-57 F.P.CO.