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APPLICATION FOR SANITATION PERMIT Permit No, (Complefe in Duplicate) f Date Issued ApliCation is'heremade to the San�Joaquin Local Health District fora e This application is made in compliance with Count Ordinance No. 549. permit to construct and install the work herein described. JOB ADDRESS AND LOCATfON_.___ ,__ �` »J4' • Owner's.,Name _ ------- .. , --------- °nAddress--- . --- -------- -------------•-----------•---------- Contractor's Name_____ __ � , -------------------------------------` - T ------ Phone-----•------------------- Installation will serve: Residence Apartment House E] Commercial Number of living units: __ ` _ Number of bedrooms " Trailer Gourt E] Motel .El Other ❑ �-`- �_ Number of baths _"�_ __ Lot size _____��(}" •_f_Q_Q________ Water Supply: Public system ❑ Community system ------- ""-"-" Y Y ❑ Private Depth to'Wafer Table'_�Q__ ft."' Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Cla Loam`E] Clay El Adobe[I Hardpan Cj Previous Application Made: Yes [I No ❑ New Construction:' YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ E] FHA/VA: Yes ❑ No E] (No septic tank or'cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well__ - --__:Distan e from fou ion__ -t1Mate 'al No. of compartments____" Size- y r /!_1 ^_ _4-----Liquid depth------ � Disposal Field: Distance from nearest well----5� I ---Capacity_-__-Lb_ap ___--_-_-_,Distance from foundation____ __ _ Number of lines__:____ -- -------Distance to nearest lot I•ne _ Length of.each line _ _ , j Type of filter material-__ �. -" - & Width of trench----�.�--- : -- ---' Depth of filter material_____ _ Total length__-__1__$�_ _______ 1 Seepage Pit: Distance to nearest well`_ _ _ _:`______Distance from`foirnda#ion____ _ r _____________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----------- ----- ----- --- - ---------- Privy: Distance from nearest well---------------------'--_ -- -------gals. - ------------- _----Distance from nearest Liquid �apgcity_.--=_`_ - ❑ Distance to nearest lot fine----------- ------------------- _ ------------------------------ Remodeling and/or repairing (describe):----------------------- 4 :' I --------• ---- ----------------------------------------••----------- - - -----------•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance.with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. � r (Signed)------------------ ------------------ D, -------------.(Owner and/or Contracfor)' -------•------------------------------•------------- - - --------------(Title)---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____-_.__._ -------------------- DATE REVIEWED BY -------- ------------------------------------------------ -------- BUILDING PERMIT ISSUED_-______.____ DATE________ _ 1 `'s4� DATE A aerations and/or recommendations:___`__________________ ----------------------------------------------------"-"---------- .-------- ------------------------------------- FINALINSPECTION-'BY_--------_-----------_ ` - - — _f.. b._..y Rep.-O ---•- --- Date----------- SAN - --------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street ,. Stoek}on, California 814 Nodi, C Street Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F,P.CO. I