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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued - --7_--.r V--- 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 LOCATI0 Y0 � f -- ----------------- t-`-"- '-------- ------ Owner's,.Name------------ -r- ''`�r -------L ------- ---------- ----------------------------------------------------- -- Phone- h--- ,5 3.2_ Address---------- -•----------------------------•----------z z ' ; -6 1 1 Contractor's Name------------------------C _W-- -- ----------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1_ Number of bedrooms __ Number of baths -1----- Lot size ___-__7. -_x_I( +_____________________________ Water Supply: Public system 9��Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Ej Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑' No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICXTIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)f Septic mak: Distance from nearest wellDistance fr_om foundation___I_6____ --_.Material_______ _�__,__w___ a ---------------- �/ No. of compartments-------Z......... Size p� --x-�f..........Liquid depth------- --------------- Capacity --,--------- _Ca acit �� Disposai Field: Distance from nearest well.'��--Distance from foundation_-- --------Distance to nearest lot line__ Number of lines-------.I-------------------------Length of each line-----IV------- of trench---- --------------------- - Type of filter material__*pvL_---__----Depth of filter material--_12-------------Total length----10_!----------------------------- -- Seepage Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- 0 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------.---------`--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material _---____.---_----________-_______ ❑ Size: Diameter------------------------- ------------De th-------------- ------ ---- - - - ----- - ------- - Liquid Capacity Y -----------------------gals. Privy: Distance from nearest well---------------------- --------------__-_____._Distance from nearest building------ --------------------------------- Distance ___,_._ ______-.---_--Distance to nearest lot line------ - -------------------------------- --- -------------------------- ---�------------------ -- ---------------------- Remodelingand/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. [Sign ) f�� ed `. 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 ! APPLICATION ACCEPTED BY--- »"{f.`v - Lr vt+ ± - DATE F 7 =-- ------------------------ REVIEVv'ED BY ------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:-------------------------- ----- -------------------------------------------------------------•----------------••-------- ------------------------------------•-------------••--------------------------•-------------------- --------------------------------------------------------------------------------------------------------------------- -- -•--------------------------------------- FINAL INSPECTION BY:---e- Date f 5AN 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-9-2M Revises 1-57 F.P,CO.