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f� �'`�'y�/ APPLICATION FOR SANITATION PERMIT Permit No. ... --------- ' (Complete in Duplicate) $ j 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, JOB ADDRESS AND LOCATION------- 1 '_---.-� ,4-- T~7U _----- --------SS' cfGz- /Z--------------------------- ---- ------------------- Owner's Name r��°m'` ----liie, _�1_/t� - ---------------------- ----- Phone----------------------•------- - Address :-------�-`----`----�----`""_6G t Ca-----� 1-r/�------------------------------------------------ w a i Contractor's Name I ±Y `►^.6�.1s�� .`� f° -------------------- Phone------------.---------------------- Installation will serve: Residence U[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O her ❑ Number of living units: _�/_ Number of bedrooms _;Zon Number of baths ___4__ Lot size _______'---- _______________.__.___ Water Supply: Public system" Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob Off, Hardpan ❑ Previous Application Made: Yes ❑ No R New Construction: Yes R No ❑ FHA/VA: Yes ❑ Noo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------- Distanlc.� from fou tion____.�sa__.____.Ma ;rel_! _______________________________ _ No. of compartments________ ____._.___Size__` " .-._____Liquid depth______ __ _.�� Capacity-- ------- - ----- Disposal Field: Distance from nearest well___'-- ___Distance from foundation____1__�__ __F.Distance' to nearest lot line_ _�____- Number of lines__________._ __ _Length of each line___________ _----- -------- 'Width of trench-------- _________ r �� aGType of filter material__ _ epth of filter material--------l�___-----Total length__________________ _____`_._. Seeppe Pit: Distance to nearest well______ .---Distance�rfrom yfoundation---- --------Disfe to nearest lgl�e,___ /n_._'___.r Number of pits-_..--------�-- ----Lining materialz+__�'!�_ � _. ^��--_---_---.Depth-------------- --------(,-�l��t�� -� ize: Diameter______ Cesspool: Distance from nearest well ______---------Distance from foundation--------------------Lining material------------------..______---___-_---. Ll Size: Diamefer------------------ ------------------Depth----------------------------------------------- -- Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------__.--------Distance from nearest building____________________________________.___. ❑ Distance to nearest lot line-- ----------------------------------------------------------------------------------------------------------------------------------------- R 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed]-_�.A.._�Y�� `--- -�., '* '"'¢"-------------------------------------------------------------------------------------------(Owner and/or Contractor IBy:.....--••--------------------------------------------------------------------------------------------------------------------------(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---------- REVIEWED BY ' "" ' " ------- DATE---------•--- -------------•------- BUILDINGPERMIT ISSUED------------------------------------ ---- -------------- -- -------------------- ----------------- DATE------------------ ----------------------------------------- mendatC ----aAlterationor .a�� ' -- --- ------------1------------ -------------- FINAL INSPECTION BY- - --------- ----------------------------- Date T /rte '^ --------- 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-4-2M , Revisod 1.57 F.P.CO.