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APPLICATION FOR SANITATION PERMIT Permit No. ....-f-C-Lf..... (Complete in Duplicate) A y Date Issued -_--__ _- Application is hereby ma oaquin Local Heal+h District fc;77pem_it-to co n-struct.and install the work herein described. /This applicati liance with Crunty Ordi ante No. 549. t "JOB DRESS A L CATI'ON„'��-!Y_ �_ J _ d_-`__-d�2--! 2. �n , - ________ _________ __ __A____- ---_--_----------__--.--_______-------_- Own r' N X11 _M - -. � hone------------------------------------ ---------- -- _ Address--------- f--- l a — ------------------ --------------------- Contractor's -----------------Contractor's Name--------------------------- ------ ----- Phone----•---•-------------------------- Installation will serve: Residence ❑Apartment House F] Commercial E-] TrailerCourt Motel ❑ Otherr E]Number of living units: -1.�Number o£ bedrooms _-.----- Number o /baths ----_-__ Lot size -- - ----- Water Supply: Public system ❑ Community system F1Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 'Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes 0-"'No ❑ FHA/VA: Yes ❑ No ❑ ,�� " TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or'cess ooi permitted if ubli sewer is available within 200 feet. . ( P P P P � ) Septic ank: Distance from nearest well/fid+---Distar�c�e kom fgun atii n--------------------Maferi L--0.9�---T��(fy..D --- Na. of compartments____._. --------I.. depth_-.--------�..--___-_Capacity-_2_Y-OO Dispos Field: Distance from nearest well/0Q__c._Distance from foundation---------- - -------Distance to nearest lot lin __ )� ,,--------- /\lumber of lines----------- ------- ------------Length of each line_-_-----_�_�i-T r-----Width of french------___--- - ----- Type of filter mater/ he pth of filter material-_-----_� --------Total length------------- 1-- _ ___-___------ Seepage Pit: Distance to nearest well----------------------Distance from foundation----. ..---.._.--..Distance to nearest lot line__..-_--__---___ ❑ Number of pits----------------------Lining material --------Size: Diameter----.------------------Depth--------------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation--------------_-----Lining material--------------- Size: Diameter------------------------- ------------Depth_---------------------------- ----------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________--.--------------_-_-------------. [� Distance to nearest lot {ire---------------------------------------------------------------•----------------------------------------------------------------- ` Rem4eiin and/or repairing ( escribi):-- _ --y________- --- I . -ti ---------- --------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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) ---------- -- -- ------- - --------- ------ -- - -- - ------ ----- --- - - - ---- -- (Owner and/or Contractor) By:-------------------------------------- --•-- ------------------------------------------------------------- ------------ -----[Ti+lei---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13 --------------------_----_-_-______ DATE- --- REVIEWED BY----------------------------- DATE-- ----- BUILDING PERMIT ISSUED---------- --------------------- --------------------------------------------------------- DATE------- ,-------------------------------------------- Alterationsand/or recommendations-------------------------- ----------------------------------------------------------------------------•-----...----------------•--•---------------------------- ---------------- -------- - -- -------- - --- -'- - ------- - --- - - 06 --)------ -- ---------------------------------------------------------------•-'-------------------------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:.----- Date----�Z�41-------------- ------------------------- 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-