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�N pr,� IvM APPLICATION FOR SANITATION PERMIT Permit No. .1.1 4 0 �__�°S..__.... (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Dis ict for a permit to construct and install the work herein described This application is made in compliance with County Ordinanc o. 549 JOB ADDRESS AND LOCATION--- - -l�'....-�a------- 1� rte ' Owner's Name ------ SCC i'tom----------------------- Phone--- Address---- Contractor's Name--------• ---- _ ------------- ------------------------------------------------------------------ Pho e----------------------------------- Installation will serve: Resi encu Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :_/._'Number of bedroom____ Number of baths _/___ Lot size ______- � ------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa rr Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: YeSo No ❑ FHA/VA: Yes ❑ NorV TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) �,,5eptic T nk: Distance from nearest weff-----------------Distance from foundation--------------------Material_____ _____. 0 No. of comparti eats-------------------- - ---Size----••--------------------------Liquid depth--------------------------Capacity----------------------- i isposaI Feld: Distance from nearest well ._Distance from foundation--------------------Distance to nearest lot line__________-______ C Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material------ ----------- ---Total length---_-------------------------------------- Seepag Pit: Distance to nearest well_____ __ _ _____Distance from f ndation_ Distance to nearest lot line__.______ O i {Number of pits__.__1____.__-___lining material T �'__-Size: Dia eter__ ..........Depth---/C�-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------'-------Lining material------------------------------_______ ❑ Size: Diameter-� ----------------------Depth----------------------------------------------------Liquid Capacity- --------------------------gal Privy: Distance from nearest well ___ _-___•___,___ _, -„,-Distance..from nearest,building_____________________________________-_. ❑ Distance to nearest lot line----------------------------------------------------- --------------- Remodel i -------------Remodeli arn*,or repairing (describe):_____ _. C T _ ,!- �___ ___ '...- --- --------------------------------------------------- - ---- -------------------- ---------- '------------------- ✓ , ------------------------------------------------------- / - --- - ----------- -- ----------------1 ----- ------------------------------------------ ------------------------------•--------------------------------------------------------------------------------- - -------------------------------------------------------------- I hereby certify that I have prepared tis application nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an re ations of the in Joa in LocA Health District. Si ned Owner and/or Contractor By:---- ------ - --------- - .� ------------------------------------------------ -------(Title �,r- --------------------- (Plot plan: s . ng si of acato, of systemrin 'relation to wells, buildings, etc., can be placed on r arse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------- `--------------------------- DATE---- •-- REVIEWED BY-------------------------------------------- ---------- ---- --------- -- - -------A——----------- DATE--�---�--�1-- - BUILDING PERMIT ISSUED---------------- ' -- - ------ --- - ----- - - ---------.----------- --- DATE---------------------------------------- ,Alterations and/or recommendations.--,,--- ------------- -------- -------------- ------ ------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------•----------------------------- --------------- --------------•-----------------------------------------------------------------------------•----------------------- `� .1C. --•-�-----=--------`-Y�----------------------------------------------- ------------------------------------------------------------------------------------- ------------I--------------------------------------------------------- ---- -- ------------------------------ ------------------ ----------------------------------------------------------------------------------------- q /-'N FINAL INSPECTION BY----------- - --- -- -------- ------------------------------- Date----------- Z) ------------------------ 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----7---2M Revised 1-57 F.RCO.