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APPLICATION FOR SANITATION PERMIT Permit No. 1` (Complete in Duplicate) S' ,y!'If •• � Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. • I JOBADDRESS AND L�OgCATION_--- ------------------ ________ ---- ------------------------------------- ---- -' -------------------------------------------- ey r� Owner's Name +-� ---�= - Phone / - f Address-------------------------��_ lo--------------------- ---------------------------------------------------------------- ----------------------------------••------------------------------ --- Contractor's Name__lf------- ------------------------------------------------------------------------------------------------------ Phone--------------------------------- Installation will serve: Residence rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms Z-- Number of baths l______ Lot size __4`r/ --- ----------_----------------------- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&�r_Hardpan ❑ Previous Application Made: Yes ❑ No WNew Construction: Yes 21<0 ❑ FHA/VA: Yes ❑ No m TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T k:` Distance from nearest well________________Distance from foundation-------------------.Material_______________.__________________________- No. of compartments-- ----------------------Size--------------------------------Liquid depth-----:-------------------Capacity----------------------- Disposal ield: Distance from nearest Nell------------------Distance from foundation--------------------Distance to nearest lot line_-__--------_---. Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material--------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well A/ from f undation----!._�____.---Distance to nearest lot ling S_ XNumber of --- Size: Diameter___2,?_A---------Dept h-,2 -------____ Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material------------------------------------- Size: _.__________________--___-____---__Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. tV Privy: Distance from nearest well_______ ___ _ ________________________________Distance from nearest building— ___..___________.__________________ . 'Q Distanceto nearest lot line--------------------------- ---------------------•-------------------------------------------------------------- --------------------------- Remodeling and/or repairing (describe)----------------------------------------------------------•------------------------------------------------------------------ -------------------------------------------------------•-------------------_----_--------------------------------------------------------•-------------------------------------------------_-_---------------------------- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, St a laws, and rules and regulations of the an Joaquin Local Health District. la'gned) .r. � -------------------------------------------------------- -------(Owner and/or Contractor) 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 APPLICATIONACCEPTED BY--------------------------- - - -- ---- ----------------------------------------------------- DATE----------------------------------------------------------- REVIEWED BY--------------------- ------------------------- ------------------------- DATE--------------- ,�^' ------ -------- ----------------/ BUILDING PERMIT ISSUED---------------------------- --------------------------------------------------- DATE------- '� --------------- Alterations and/or recommendations____________ -------------------------------------------------------------------------------------------------------------------•----------------------------------------------•---•------------------------------------------------------- --------------- ------- - -----••------••-------- ------------------------------------------------------------ -------------------------------- --------------..-..-----------------------•----------- _� r } t l.4'' /M ------- -- - - ------- - - -- - ' --r FINAL INSPECTION BY:--------� , H. 2, Date-------�= SAN JOAQUIN LOCA HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street C Stockton, California Lodi, California Manteca, California Tracy, California ES---9-211 , itevisea 3.57 F.P,CO. i