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1 / APPLICATION FOR SANITATION PERMIT Permit NO; ---------- --------'----- v (Complete in Duplicate) � 5 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 ____ ��' --- - ---- ------------- - - ----------•-------- ----------------------- - Phone------------------------------------ ------------- --------- -------•----------------- Owner's Name-------- -- - --- - ----- ------ ---- - --------------------- -- -- - , ..�` ---- ---- - - --- L/ -------- --------------------------------------------- ---------- Address-------- {- ..._ ' ------ Phone----------------------------------- Con#rector's Name-------------- - --- -- - --- -- -- - --- -[/LJ- -- - installa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths --/_. Lot size , -�X-lf ---------------------------- Number of living units: ---/._ Number of bedrooms i Water Supply: Public system U_Commuriity system El Private ❑ Depth to Water Table .Clay E❑ iardpan E]Adobei Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam El Clay Loam ❑ Clay Previous Application Made: Yes ❑ R No New Construction: Yes U?'No ❑ FHA/VA: Yes Rg-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)_ 14 Material l----& �� ---------- Septic Tank: Distance from nearest well___/_k#/�uistance from foundation__.._ -- Ca aci -Q- No. of compartments------�-' -Size-t --- - P Liqu:d del?th__. ---- ---- -- p ty l I �� .____Distance to nearest lot line__ ____________ Disposal Field: Distance from nearest well_ 'Distance from foundation---� -- yr Number of lines---_ - --. Len th of each line___.�--0------------- Width of trench----�rf!--------- r g i> Total length g Type of filter matenal��__ __ _____ ____Depth of filter materfa4_,`� ___� 'Distance from f ndation__�Q_.''---Distance to nearest lot line_--�__ Seepage Pit: Distance to nearest well--- -- /> > ./� ----Size: Diameter-_ , --------De th- -AP ------------------- r � Number of pits------- Lining material_ ___ . - _- � p Cesspool: Distance from nearest well-----------------Distance from foundation.-------- material-----..------_-__------------ ❑ Size: Diameter--_--- --.Depth----------------------------- ----------------------Liquid Capacity 9 Privy: Distance from nearest well_- ------- ---------- ----------Distance from nearest building------------------------------------------ LL Distance to nearest lot line--------------------------------------------------------------- 1 Remodeling and/or repairing (describe):__..------- ---------------------•------------------------ . ,t... .. - --------------------------------------- ---------- ---------------•------------------------------ ---------------------------------------------------------------------------------------- ----------------------------------------- ---- ------- --------- ---- ------- ----- ---^---------------------- 4 1 hereby certify that I have prepared this application and Lha+ the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguI do s of the San Joaquin Local Health District. rContractor) , .(Signed) � / (Title). -- ---------- By:----------------------•--------=_ ------ ---------- p (Plot pian, showing size of•lot, Iota of system in relation to wells, buildings, a+c., can be laced on never side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ----- -- DATE = DATE------------ ,-a -------------------- ------- REVIEWI D BY ---------- E ----- -I A)`----------------- --------------------- BUILDING PERMIT ISSUED ------------- ------------------ DAT ` Alterations and/or recommendations:_______..___ ` - --------- R -------------- --- ----------------------------------- - ----------------------------- =----- -------------- Date. ... -- -------------------- �JNAL. INSPECTION BY:.--- . N JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street '814 North "C" Street 130 South American Street Trac California % Stockton, California Lodi, California Manteca, California Y ES-9-2M'.,_ Revisoa 1-57 F-P.CO.