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j APPLICATION FOR SANITATION PERMIT : hermit No.. ._�l1_ _ l___ (} l D i l C { ompete n Duplicate) 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 Or inance No. 549. JOB ADDRESS AND LOCATION_ . �[T/Jj ---- ------ ..�...�_....__----17 Owners Name---•-�----�-- ---------" ------ • -- --- ---- ------ Address-------------............ ` _ ------------------ -------- ----�-�--- -------------�- -- Phone A�• �------------ ----------------------------------------------------------------•--------------------- -------- --------• -------------------------•----- Contractor's �. ------------------------------------------------------------------------------ Phone.----------------•---------------- Installation will serve: Resident F1 Apartment House El Commercial F] Trailer Court ❑ Motel ❑ Other ❑ f II i Number of living units: I_-_... Number of bedrooms2—.- Number of baths .1---._ Lot sizeQ--------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .. ft. Character of soil to a depth of 3 feet: Sand ravel El Sandy Loam El , ay Loam ❑ Clay ElAdobe [ ardpan El Previous Application Made. Yes F1 No New Construction: Yes la ❑ FHA/VA: Yes ❑ No [LYS TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Sep ' /Tank: Distance from nearest well---------------- Distance from foundation--------------------Material-----------------------......__----_----.-_. _ No. of compartments---- ---- ---------------Size---------------•----------------Liquid depih--------------------------Capacity----------------- is os Field: Distance from nearest ]"ell.--NQ Distance from foundati /(�-__...-_.Distance to neares# lot li e� ....._. -.a. Number of lines__.-__.._./__-.. Length of each line------ __a_.._.._J 7,Width of french----- f --------------------- ! Type of filter material.__---- p Depth of filter material.______Ir------Total length.__...-�..._--_------------------ Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line---.__...... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------- f Cesspool: Distance from nearest well.................Distance from foundation--------------..___.Lining material-----------------------------------._. ❑ Size: Diameter------ -------------------------------Depth---------------------- Liquid Capacity gals. �- ' Privy: Distance from nearest well------------------------------------------------- from nearest building-_____.._...------------_------.-------- r ❑ Distance to nearest lot line--------- ---------------------------------------------------------------------------------------------------------------------------------- f 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. ([Signed)-- __-- --. --------- ------------ Owner and/or Contractor . Title y......-- ------------- - ---- ----- [ ' ---------------------------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / E APPLICATION ACCEPTED BY------- - ------------------------------------------------------------- DATE--------------- REVIEWEDBY------------- •------------- ---------------------------------------------------------- DATE--------y--- -- ---- -------------- BUILDINGPERMIT ISSUED----------------------- -------------------—------------------------------------- DATE----- --- ------------------------------------- Alterations and/or recommendations:------- - -------------------- •--------------------------------------•----------------------------------------------- --------- ---------------------------------------------------------------•---------------------------------------------------------- ---------------------------------------------------------------------- ------------------------I-------------- ----------------------------------- FINAL INSPECTION BY:. - -��-- ------ Date. --~-a-�---`�- 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-9-2M , Reviseci 1-57 F.P.CO. f