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APPLICATION FOR SANITATION PERMIT Permit No. _;�-1 rov---__ (Complete in Dupleate) 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 L CA ON_-_�Jf-INN �- ` ---- -------- 94 Owner's Name - - --`----- f ------------ _:- Phone - ------------------- - Ole ----------- ----- Address----------- 'S Contractor's Nam e__.�r�= �14.• ' -------- ---- �r Phone ----- � = Installation will serve: Residence UD0"Apartment House•❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /_--- Number of bedrooms___ Number of baths -/_ Lot size _ -. 40.e Water Supply: Public system 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 Previous Application Made: Yes ❑ No New Construction: Yes No ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tpk.- Distance from nearest well- ------Distance sfrom foundation----1-8_ Ma erial---�/ t _-_-_-__ € No. of compartments----------Z--------------Size---3_l't__X_J_ _4kiquid depth----- ----U---------GapacitY--- �-- ------ Disposal Field: Distance from nearest well__ Distance from foundatipn-,-1 �`�-!___Distance to nearest lot line___4 --c:,. I Number of lines-------------�----------_ Length of each line--------- -:7Q__:------_.Width of french--- _'V `_....................... Type of filter material__-_---- -Depth of filter material---1.8---------------Total Seepage Pit: Distance to nearest well-----------_--°-----__Distance from foundation--`----------------Distance to nearest lot line--_-__-----_----_ ❑ Number of pits----------------------Lining material----------------------Size: Diameter--------------- ----.Depth--------------__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining I material--____--____-_-_---_--_____-_ El Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building -. ❑ Distance to nearest lot line------------ Remodeling and/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 Loca Health District. -- (Signed)---- ------------------------(Owner and/or Contractor) BY: -- (Title) / r (Plot plan, showing size of lot, location of system,in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE REVIEWED BY---------------------------- DATE /.a 'S ------------------ BUILDING PERMIT ISSUED--------- ------- �' ----------,' ------ ------------------- ------------- DATE-----Alterations and/or recommendations_ _______________ ----------------------------------------------------------------------------------------- --------------------------- ----- - --------------------------------------- 4-- ------ ---------- FINAL INSPECTION BY:-----W__ V-_ ----------------------- Date------- r U� 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 8-51 Revised W-2100