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APPLICATION FOR SANITATION PERMIT Permit No. ____`>__!F.?�-----.- (Complete in Duplicate) Date issued ---- Application _ _Application is hereby made to the San Joaquin Local Health District for a permit to construct.Vn install the work herein described. This application is made in compliance with County Ordinance No. 549. �� y JOB ADDRESS ANP, LOCATION_ , .c.. r� ' (/ f d -------- Owner's Name---- ----------------- Phone Address l--`--- C ' �I` �� ' �`------- Contractor's Name------ -. ---- -- -------------------------•--------- ------ Phone----------------------------------- Mofej will serve: Residennte X Apartment House ❑ Commercial ❑ Trailer Court A Mot ❑ Other ❑ Number of living units:T`-S Number of bedrooms _ Number of baths ___�__ Lot size ________ -. p ------------ -- ,p Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table L.-O- f�'�j°'"'�t 8'�I ,� Character of soil to a depth of 3 feet: Sand ❑ Gravel y Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No IN New Construction: Yes No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) sy acc-t-y-..._" " -- - Septic Tank: Distance from nearest wel___-&--6 _ Dita ce � fours aiion___:__ _---___-mat 'ay �_ _ _.- -- � J No. of compartments---�- Size�_1.f-_ -----�- ---Liquid depth Disposal Field: Distance from nearest well._.------------._Distance from foundation--------------------Distance to nearest lot line----------------- J a , Number of lines-----------------.-----------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material----------------------Total length------------------------------------------ V, Seepage PA 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 0 Privy: Distance from nearest well._.-----------_----------------------------------Distance from nearest building-----------_____-__________---_ Distance to nearest lot line--------------- . - ------------ ---- ----- - -- ;- ------ Remodnd/orepairin sQ- ------ ------�41 - ---- , --- •---- -------- b -c---- - ----- - -- - - ke '1/i bra. ;�1 * 'i• t_ r I hereby certif that i have prepare this application and that the work will be done in a ordance with San Joaquin County `.. ordinances, St la laws, and rules and regulations of the San Joaquin Local Health District. Si ned --------- -------- -------{Owner and/or Contractor Title (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- ----- ---- ---------- ----------------------------- DATE--------------- ---------------------- ---- �. - f - DATE REVIEWED BY A�� . �� BUILDING PERMIT ISSUED-----------------------------------------/------------ ------- ------ DATE. Alterations and/or recommendations---------------------------------------------------------------------------------------•----•--••-------------------••------------•--------------•------------------------------------------------•---------------------------------------------------------------------------------- ---------------•--------------------------------- ------ ------- Date �— FINAL INSPECTION BY--------------- ---------- --------------------------------------- S ----------- ---- 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 Revisea 1.57 F.P,CO.