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APPLICATION FOR SANITATION PERMIT S Permit No. (Complete in Duplicate) I� �' 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____--: _ _ _ _ _ ----------------- - Owner's Name--- = = I'hone------------------------------------ ----- 24 Address-------------- Z?------•�' � ---- . ----= - -- - - Contractor's Name--------------------------�-- ---- --- Phone _�'_ �--- i ' rD Installation will serve: Residence N`-Apartment House ❑ . Commercial- a/ Trailer 'Court ❑ Motel ❑ Other ❑ � Number of living units: ---/_ Number of bedrooms'-2--' Number of baths ---/ Lot size ....... .... ...VQ----------------- Water __ ____________Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z?-Orardpan ❑ Previous Application Made: Yes ❑ No ffr-;;New Construction: Yes No ❑ FHA/VA: Yes [�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,.,Of (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)- * -. Septic T Distance from nearest well_ __Distance from foundation___1_ ..._____..Materia _` ----- ----------------------------Y�` � -------- -- - No. of compartments-------- 2----- � ------Liquid depth------- -._Capacity____$'�i!1_--- 1 Disposal F' .- Distance from nearest well___ __ ________Distance:from foundation_ F -----------Distance to nearest lot line________________ Number of lines_:____ __ Length of each line____- --------- ---- 5�---------- ----Widfih of trench-- --- -- - -------------------- Type of filter material-�___�i p ' Depth of filter material._..__f 9-------- otal length____________.___/4�__-_______- i �7 i See a e Distance to nearest well_ -O - ------ m fo dation____. ___�__----Distance to nearest lot-iine_-__ ________ p g Number of pits.__.+:___._______Lining material--- .Q.,._Size: Diameter__.. c ..----___Depth_..�_�4____________________ Cesspool. Distance from nearest well_________________Distance from foundation----------------------Lining material-------------------------.___________ ❑ Size: Diameter ' Depth quit Capacity- ---------•---------- g __Li ui els. Privy: Distance from nearest well ______---------------------------------------'_Distance from nearest building___------------------------------------- Distance _ ______________________________- Distance to nearest lot line--------- -------- ----------------------------------`-------------- -----------------------------------------------------I---------------- P Remocle4ing and/or repairing (describe)------------------ ----------------------- --------------------------------------------------- -------------------- ----------------------------------- ---------- -- -=---------- -----------------------------:---=---------------------------------------------•----------------------------------------------------------------------------------------------------------I-------------------- x -------------------------------------------•--•---------------------=--------------------------------------------------------------------------------------------------------------------------------------------------------- C ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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, an r les a re a ons of +he San Joa urn Local Health District. (Signed) Iq -------- . -- [O her and/or Contractor) ly--------- : J� �_�'`�'" (Title) (Plot plan, showing size of lot, location of solem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -. DATE-�------------------------------------------------------- REVIEWED BY---------------- ------- ------------------------- DATE_ --- BUILDING PERMIT ISSUED �� - DATE-- -`Vv---------------------------------------- Alterations arid/or recommendations:---------------------------------------------- ---------------------------------------------------------- �.------------------------------------------------ - ------- -- - -------------------•--------•---------------------„-------------------------------- --- -- yew _r r --------------------------------------- FINAL INSPECTION BY--------------- ----- - -i Date------ .;/ '�------- -----}----- 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 i E5-9--2M Revised 1.57'F.P.CO.