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f APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Data Issued ...1....a1.... ... . 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 CATI N - -: ,.. ---------- ----------•-----........ ................. Owner's Name.... Z1114 + Phone_.............. ................... Address._......A.r.._./... / ..- -------. . . _._ Conlractor's Namur .si��1 .. ---------------- Phone-_._._._-.--------...... Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. Number of bedrooms ...... Number of baths •------ Lot size . - - Water Supply: Public system F-11 Community system ElPrivate,�f Depth to Water Table-%7% ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam. Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 4E New Construction: Yes tj No ❑ FHA/VA: Yes n No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest we.L.Pr -'-'--Distance from foundaiion__/q..'___.----Material.......... . Ll - - - No. of compartrnerits:..y�;- . _." Size._..:_."._.:..__.. .___":.._Liquid"depth...................... . Ca Capacity /_ — I� Py----� . - .-- Nsposal Fie'd: Distance from nearest we]of."-_-_...Distance from foundation.1K_...........Distance to ncoresj lot line.......... Number of l;nes.._._*7, -L n th of each Iine___. _D' !� -•-- ----- 9 g ------- -----._.Width of tren�ch�.. ,��.�..�. ,T,. . .._ Type of filter material of filter matcr'al _f ".._._._.Total length- t +'1.__.... p Seepage Pit: Distance to nearest well........... ....Distance from foundation.................. .Distance to nearest lot line.. ❑ Number of pits.------..........._...Lining material---_-------_ Size: Diameter. .................. Deptn.............. --- ----- - ---_ (57 Cesspool: D;star.ce -.rom nearest well.................Distance from foundation.. .- Lining material.__....... . 1 I ❑ Size: Diane°cr. _.... ... .......------------Depth........ ...................... ... -- . ...Liquid Capacity .................... ....... ..... . ...-.._gals. — Privy: Distance from nearest well........... . .......... .....................Di<_tance from nearest bu;id;rg......-_................................. r❑ T._ Distance to nearest lot line.__........................... ..............•--................•........... Remodeling and/or repairing (descr;;'De):... .... ... .................. - — .......................... ...--- .......------.........-••-••-•---....---•••---------..._._.------------------------------------•-•---•-....._............_..............----------•---........--•-----------•- ------- ----------- ------------------------------------------------------- ............... -- ---------------.. . ......................-................ .............................. 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 egulations of the San Joa in Local Health District. _! (Signed)... '.1.......................... (Owner and/or Contractor By:.. r . .. ------ - - _-_ ------ - (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. . .................. DATU-0.- '.'J�_'r-------- _ REVIEWEDBY............................................ .. . .•-------_----•------. .. .......................................... DATE.------•-•--............--•-- _........._.. BUILDINGPERMIT ISSUED........................................................................--••-----................... DATE................. ............ ............................ Alterationsand/or recommendations:_.................... _.......... ......................................... - ------------_-------- ------------------------------------- ............... ......................... .. .............. ..............I . / ........ ./ r , ___�--=T`/-..`�.•'..•!C ..-. .. ..� J..............j'�'...�.. .Y �"'.�/.��r.��/f��.... ....... � i/� .•..__. ..__....-- _•_____.._... *_,)9.1-.,4.,"... ..................... ........................--........__...._.._...... ................__._... . ...........................................-.-................ -r-'-- ------ . e-- ' -�y?�t..A... .......... ................• ........-------•---..........----._.._......._.. .._........-•-•-------- ..................... FINAL INSPECTION BY:.. _ .. - .... Date../.2--/.r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 Want Oak Strut 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.