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APPLICATION FOR SANITATION PERMIT Permit No. f ` (Complete in Duplicate) ' K 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, ri JOB ADDRESS AND LOCATION-' :3< --------=-------- -- -------------- -- -------------------- - --- --------------- -- - Address_--- Phone- ----------- 2 0� -e - ` — •-4- ------ ---------------------------------------------- - - -- Contractor's Name ---------- --_-- •_-- ---------------••- - ---- --------------------------- -- [�}/ A - ------ ----- -------------------------------•-. Phone- Installation will serve: Residence --.--------�---------__•-______ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _-_ Number of baths Lot size Water Supply; Public system - --- ---- Y ❑ Community system ------------ Character of soil to a depth of 3 feet: Sandi . ❑ Private epth`to Water Table -- ----- ft. ❑-. Gravel S dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Previous Application Made: Ye - '"No,��! Hardpan ❑ ❑ Lam' New Construction: Yes ®r''No ❑ FHA/VA: Yes ❑ No 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__ 0;S/ ? ---.-__ Dista ce from foundation__ __-- _--------- Disposal _ �_ Material-_____ No. of compartments �� Size_' Disposal Field: Distance from nearest well_..-_ Liquid depth__. Capacity. - a acit .__ �_ G __.Distance from foundation___p y r Distance to nearest lot line___ Number of lines__ S______ ------------------- Length of each liner^' �- Width of trench /� Type of filter ma terial-_______:x�, Depth of filter materialjl�__�_-_ Total length 6 Distance to nearest well___ _ / g ----•------------------------ 0 -----_____Distance fr m fo ndation_____ ________D�stanjre to nearest to ine_._ Number of pits_____________/ -----_Lining material __-__� Size: Diameter__k].-epih_- --------- Cesspool: S ------------------------- Distance from nearest weft__ -_______.____Distance from foundation _____-__-_-•.___.Lining material------------------------------------- Privy: -___________.______--_ _ R} ❑ Size: Diameter ----- ----------------------- Depth ------- ----------- - --------------Liquid Capacity - Privy: Distance from nearest well-___'___ --__-__ --__ -------.gals. ----------------- - Distance from �nearest building-------------- ❑ Distance to nearest lot line- - - ----•--------•-----------•- ------------ ------------------------ emadeling and/or repairing (describe)___________________ Ib --------- •--------=-------------------=------------------- ------------------------------------------------ --•--- --- ------------------------ -- ---- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. qu n County (Spned)--- --------------------------------------------------------------------------------------- (Owner and/or Contractor) ------------------(Ti tl ------------ -- (Plotan, showing size of lot, location of system in relation to wells, buildings, s, etc., can be placed on reverse side}. t FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY_-__ _ __- - -------------- ------------ DATE REVIEWED BY i - BUILDING PERMIT ISSUED-------- -------- - DATE ----------------------------- ------------------------------------------------------------ t--------------------------- ------ i ,Alterations and/or recommendations------- -- -----------__------------------------. DATE----------_---_-__-- _-- �,k e�.--------- - - - ---- --------------------------------------- -------o------- ',.Q. � - - ------•----- FINAL INSPECTION BY:-----_-� �� eaH.`.a"t�d 1�eA t s4� Date-_ °3,._--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 5ouih American •Street� 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 North C" ir�t - Manteca, CCalifornia Traey, Californnia ES -9-2M . Revises 1.57 F.P.CO.