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�S APPLICATION FOR SANITATION PERMIT Permit No_ _____7 (Complete in Duplicate) 0-/6-1K' Date Issued ___ �\ Application is hereby made to the San J aquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with Coouunty/JOrdinan e No. 549. JOB ADDRESS AND .CA IO ------ 1-- d-------- --- --------- -- -------------------------------------------------- _ --- --------- Owners Name _ , . Address- Contractor's Name - ,-- ----�- ------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment i Ouse f-Commercial--E]— Trailer Court-E] Motel ❑ } Other ❑ Number of living units: j--- Number of bedrooms Number of baths _______ Lot size ____ ,� Water Supply: Public system ❑ Community system l❑ Private U?"6epth to Water Tableyj;`�l ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy-Loam oam ❑ Clay Loam ❑ Clay ❑ Adobe fardpan ❑ Previous Application Made: Yes ❑ No g4--14ew Construction: Yes ❑ No [LelF�A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [' (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well_-O----- ---Distance from foundation-/__11-----------Material_`__-(___ No. of compartments---._.._�_)____._.__Size_ 3_x �o/.-_-___-Liquids epth_V-�k,-----____Capacity___ _ r _ Disp^osa�l Fi Id: Distance from nearest we€i___�--q.___ _Distance from founclatio ___. ____:_''Distance to nearest lot line_-____._.S____ LR Number of lines'�z__,__ ________, �___ Length of each line_______ s_Q 1__________-Width of trench___ ,�___��------------------- Type of filter material _+ ! --Depth of filter material____ _ __________Total Eength___ G_.`__________________________ _ Seepage Pit- Distance to nearestwell_.11-^.__-------Distance f f ndation____-�_�----.Distance to nearest lot line-------- Number of pits------/_____________Lining material---- 1 __Size: Depth----0? ,fit__-----________ Cesspool: Distance from nearest�.well-----------------Distance from foundation------------------- Lining material-___________--------_--______________- El Size: Diameter--------------------- ----------------Deth----------- ---------------------------------------Liuid Capacity gals. k Privy: Distance from nearest well______________________ _________.___i____.___Distance from nearest building-__- �> --------------- Dis#ante to nearest lot line- --------------- ---- ---------------------------- ---- ---- --- ---------------------------------------- Remodeling and/or repairing (describe)----------- ---------- t------------------------------------------------------------------------------------------------------ -----------------•-------_----•---------------------------------------• --------- ----------------------------------------------------------------------------------------------------•------------------------------- h f E I hereby c.r fy that i have p epared'this application an`d that the work will be done in accordance with San Joaquin County ordinances, StL- 7 d ides rid regulat' ns of th SankJoaquin Local Health District. (Signed)---------- �(Oand/or Contractor) By:-------------------•--•-----•------------- ---• ......r (Title) (Plot plan, showing size of lot, location f sysaem in relatioro ells, buildings, etc., can 6e placed on reverse side). •F FOR DEPARTMENT USE ONLY,,-V, i APPLICATION ACCEPTED BY------- ----------------- -------- --- ------- ------- ---------------------------------------- DATE------------=----------- ---- ------------=--------------- REVIEWED BY----------- --------------------- ;Lv - SATE ---�- -- -- BUILDING PERMIT ISSUED---------------- -------------------------------------- DATE--�---- -------------------------- - Alterations and/or recommendations--------=--- ------ ------------------ -------------------------------------------------•---------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------•--- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- �- r FINAL INSPECTION BY:.- --__-- 1S ------------------------------- - ---------------------- Date-��!---(�---------V-- -------- SA 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 }.57 F.P.CO.