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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 97/ Application is hereby made to the Son Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A D LOCATIQN ------------- -- ------ ----------------------- ------------------ Owner's Name-- I -- -------- ------ --- - -- ---- - -- - ----------------------------- 1 ------------------------------------------ Address__ --- Phone ------------------------------------ Address------------- 600- . - --l-3 - ---------------------- ----- --------------------------------------------------------------------------------- --------------------------------------- Contractor's Name ---------- --- -------- -------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence , Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other El Depth to Water Private i ---------------- El Number of living units: --- Number of bedrooms ------ 2oWmber of baths --- /-- Lot size jr4411� Wafer Supply: Public system 0 Community system Tablet____ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam [I Clay Loam El Clay � Adobe E] Hardpan ❑ Previous Application Made: Yes [j No V New Construction: Yes 9, No E] FHA/VA: Yes [] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Septi Tank- Distance from nearest weil;h* *______Dist f f founclation-J& ----------- M; P c fromat_________________________________________________ e T, J;-4RD -------- No. of compartments_________ ------------ Si, Liquid depth__.- ---- ----- ------ Capacity Dispo al Field: Distance from nearest well -/:W---.- Distance from found.�Jflon--/--100 -- ------ Distance to nearest lot lin X L Number of lines -3 ----------------------------- Length of each of -------------------- Type of filter mafer;al-jL t* -4 -/C -Depth of filter material --- 2,-j�--_4 ----- TofaI length-- -------------------- Seepage Pit: Distance to nearest well ----------------------- Distance from foundation ------------------- Distance to nearest lot line_____------____-_ El ine----------------- El Number of pits ----------------------Lining material -----------------------Size: Diameter---------------------- Depth---------- ---------------------- Cesspool: Distance from nearest well ----------------- Distance from foundafion -------------------- Lining material___________------____._-__________ ❑ aterial------------------------------------- F1 Size: Diameter --------------------------------------- Depth ----------------------------- ----------------------Liquid Capacity ----------------------------gals. Privy: Distance from nearest well ------------- ---------------------------------Distance from nearest building ------------------------------------------ ❑ - - -------------------------------------------------------- Distance to nearest lot 1ine ---------------------------------------------------------------------- Remodelingand I /or repairing (describe): ------------------------------------------------------------------------------------------------------------------------------------------------ - ------- ------------------------------------------------------------------------------------------------------------------------------------------ ---------------------- ------------------•------------------------------------------- -------------------- : ---------------------------------------- -- - ------------------ ---------------------- ------------------------------- -------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- I -------------------------------------------------------------------------------------------------------- I hereby certi that I have prepared this application and that the work will be done in accordance with San Joaquin County !I Health District. ordinances, Sfa no4aws, and rules and regulations of the San Joaquin Local He (Signed)--- ------------------------------------ (Owner and/or Contractor) --4� -- -- I ;"�1-14-0-71`4 ------------- ------ ----------------------------- By: .... ------------ ------------------------------------------------------- --------------------------------------------------------- (Title) ---------------------------------------------------------------- (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 BY ----------------------------------- DATE ----------- REVIEWEDBY--•----------=---- ------------------------------ ---------------- DATE ----- --- / ------- BUILDINGPERMIT ISSUED -------------------------- ................. . -------------- DATE----------------------- ---- --------- Alterationsand/or recommendations: ----------------------------------------------- ------------------------------------------------------------ ------------------------------------------ ------- ---------------------------------------------------------------- ---------------------------------------------------------------------------- -------------------------------------------------------------------------------- ---------- ------------ -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- --------------------------------------- ---------------------- --------- ------------ - --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ --------- -- ------ --------- ---- --------- ----- ---- -------------------------------- ------------ -------------- I --- FINAL INSPECTION BY---------------- ------------------ Date ----------- ------------------------------- 130 South American Street Stockton, California ES -9---2M Revisea 1.57 F,P.CO. SAN JOAQUIN LOCAL HEALTH DISTRICT 30D West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California