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APPLICATION FOR SANITATION PERMIT Permit No. (Complefe in Duplicate) Date Issued s"- /�--1-- 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 ,i compliance with County Ordinance No. 549. D(7- JOB ADDRESS AND OCATION_-... = �' -ytr..._....-.�..-Y- ------ . ..-"-------.__ . 4�C.Cr.... _ .. � . ------ Phone - Owner's Name _-- Address........ r�- -- �/ ' '�//.2. •/��+ one----•------------_---------- --- Contractors Name-.� �t�_.�.,.n�q - iu_�._. �'r-----...-..._.._..----- el Installation will serve: Residence ❑ Apartment House ❑ Commercial ,�] Trailer,Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ........ Number of baths .... Lot size _ ..16trsti+or lke--_.............. Water Supply: Public system ❑ Community system El Private @ Depth to Water Table. Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ . No ❑ New Construction: Yes ❑ No ❑ FHA%VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:— (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well/ ..-- ---Distance, from ..................... No. of compartments-.... -.................Size.crr "r_ ...------..-----Liquid depth.----.... ................Capacity_*%`�7!--- -- Disposal Field: D stance from nearest well_`o.-----._Distance from foundation--. ....... .Distance to nearest lot line--. ......... Number of lines Length_..j..-....... _Length of each line....-__-_��---------.....Width of trencha.3�"---.... .-.--.---.. . Type of filter rnatcriay --� =Depth of filter maierial__-/99.- . ..Total length___ ____________ .......____--_ Seepage Pit: Distance to nearest well...i..................Distance from foundation................. to nearest lot line.. .............. �S 1 I] Number of pits...... ............Lining materia!......... -------Size: Diameter........ Depth ......... . ..... Cesspool: Distance from nearest well-------- ._Distance from foundatio-i----------------- Lining material ...-_. ........... _-.- ❑ S'ze: Diarneier--------_------ '--•-•----------- Depih.----- ---- ................... Liquid Capacity----- --------------_gals. � Privy: Distance 'corn nearest well._.}.__..__ Distance from nearest building............. -.------_-._...... . ❑ Distance to nearest lot line._ � - ... ................................... - - --------------------- -- ............... 11 � ; t Remodeling and/or repairing (describe)=-•-....---------� . S./ ........ . ................................................................................... ------------------- - J-' i' -------------- .............•........------------------=................................... ...--- ----•--------- --- ------------------------ ---------- -------- I --------------- 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. n i Owner and/or Contractatj (Signed)..,.. .......... . .._ 1�_ _ �.._ -....... �^ .-... "u� ' J -------- ------- . -.-.•.._.... . ----•--- -----• --(Title)-- --------- - ------- .- ay:- .. , t (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-.. tea -+ ---. . --------------------- ------ ..-- REViEWEDBY--------- _----•-----•---------- DATE_ -- -----•------------- ----------------•--------------- BUILDINGPERMIT ISSUED--------------------------------- .-.---••-•------•------ DATE------ -....-..---------- - ----...--•------•...-------- Alterations and/or recommendations •.....:................................................................ .:.......•-•-----.................................................................. --•...............•-•-•-----------••-......................................... ............................................................ . ............................................................ ...........................__............................... .............. •...........................•--- .......-•-..-.-_..........----._...._......._......•••----....... ......... ------ ---------•--............... ................. ...................... ...... - .................. ................................. FINAL INSPECTION BY _.-. :- -. - ------ ----- _-..... Date. "-..._..... ...-.. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 340 West Oak Sfroot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M - Revises 1.57 F.PCO.