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�'7 I APPLICATION ICOR SANITATION PERMIT Permit No. (Complete in Duplicate) I �i Date Issued _ -1-_4-- �4-Q9z-cs - 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. J0 13 AND' L T jOwner's Name----------- h ------------------------- P Address----------- _ j + Contractor's Name____________________ •----------------------- Phone - ------------ ------ ---- - ❑ ❑ Other Installation will serve: Residence Z-artment House ❑ Commercial ❑ Trailer Court Motel ❑ Number of living units: _ Number of bedrooms __Z- Number of baths __/_- Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ! ftp Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam s Sandy ❑ y �'�lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9�'�New Construction: Yes [] No [��FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ept'c ank: Distance from nearest well-______.________Distance from Afoundation-------------- No. of compartments e ..___.Matariaf_________________________________________ ---------- ---------- i ------------------------ y ------Liquid depth_---------- ------Capacity------------------ W Disposi field: isfance from nearest welL_��--._Distance from foundation_- ,�Q Distance to nearest lot line__ — J Number of lines-------- ----- ---------- -----Length of each line------_ /� g -- Width of french.--- -!- ------------ -- t� ` Type of filter material-_� Yp _ __ __________Depth of filter material___��%-_--Total leng#h______ / ------ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest bot line F1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- 1-1 Size: Diameter-- ---------------------------------Depth--------------------------- - ---------------------Liquid Capacity Privy: Distance from nearest well-------------------------.-----------------------------Distance from nearest building ❑ Distance to nearest lot line__________________ _ __ I 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 r gulations of the S Joaquin Local Health District. (Signed)------------------------- --------- - ---- - ------ ----- -- -----------(Qrtere"dl ar Contractor) Y� ------------------------------------- --- - ----- - ---------------------- --------.:(Title]---------- (Plot plan, showing size of lot, Iota+; f system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY •__ �---------- ---------------------------------------- DATE---------- -i - ,ear- REVIEWED BYf � -•---•------•---- -------------------------------------------------------- DATE----------- BUILDING PERMIT ISSUED-------------------------------------------- i ----- •-----------------•--------- --------------- ------------- DATE----- --•------------------------ ------------------------ j Alterations and/or recommendations:_____-_.__.__________ _____---___--------_-_-__- — -----------•------ ------------•--------- ---------------------------------------------------------------------------------------------------------------------------------------- FfNAL INSPECTION BY:. ----------------- 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—:2 , .w, Revised 157 F.P,CO.