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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _ S 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--__ ,, - '--- J' ------------------------- -------------------- ----------------- Owner's Name------- --- Phone------------------------------- Addressp-- ---------• ------------------- -•--•--- ----------•--�------•-----------------------•--------- r Contractor's Name - . .... ----. - Phone Installation will serve: Residence PV Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- -_-- umber of bedrooms .--fdumber of baths _ Lot size ________�___�.-_.�___,__(_ Water Supply: Public system :❑ Community system ❑ Private X Depth to Water Table 10 ft. 1 a Character of soil to a depth of 3 feet-: Sand [-] Gravel E] Sandy loam ❑ Clay Loam E] Clay [3 Adobe Hardpan [I Application Made: Yes ❑ No � New Construction: Yes ❑ No FHA!/VA: Yes E] FNo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' t Septic Tank: Distance from nearest weal___" Distance from foundation--- ____.Material------ _____________________________`___-_-__--. No. of compartments izeuid• --------------------------- q F? Capacity Li depth _ Ca acit Disposal ed: Distance from nearest w fl_____ 5.`- Distance from foundation__ __rL,r ...- Distance toFnearest lot line___ r Number of lines-- Length of each line---------- Width of trench______ �1 � rr �-- Type of filter material-____ ,,_ h of filter 'Material_______,l__$:__...-Total length-------- —1;?--------------------- 4 . .,. I Seepage Pit: Distance to nearest weii:-_________________Distance-from.foundation__`-:___ ____=_ _.D.istance to nearest lot line---------------- Number ofits`_'.`;--. --- ❑ p Lining material Size: Diameter---•------------------Depth------ ------------------- : Cesspool: Distance from.nearest well-----------------Distance from foundation---.'--------:------Lining material-------------------------- ___________. ❑ Size: Diameter---------------- ----------------------Dept h----------------------------------------------i------Liquid Capacity---------------------------gals. Privy: Distance:,rom7n*earest--well--,----- ~'_ ___ " _'-- --- Dstance from nearest'buildin g-K- ------- i ❑ Distance to nearest lot _ line-= :.. - -------- ------- ------I---------------------------------------- -•--------------------- Remodeling and/or repairing (describe):_____- ------ ----------- _�-��----------- ------------------------------------------- � -----------------------------------------1 •--------------------....-------------- t -----------------. 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 Joaquintocal;Health District: $ .-•--•- ----------- . -- --------------------------------------------------- R� -------------{Owner and/or Contractor) i ne Y'- -•-- ---------------------- --------- ----------• •---- _--- it e ------------------------------------ -- (Plot plan, showing size of lot, location of system in.relafi n to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------------------------------------ DATE �`f.t REVIEWED BY =- = = ` DATE---------- BUILDING PERMIT ISSUED = `------------------- -- ---------------------------- DATE:--------------- = Alterations and/or_recommendations----------------------------- -------------------------_.-- ' -----•--------------------------------------------------*-------•-----------=---------------------- --------------------- ------------------------------------------------------------------- ------- ----- ----- - - FINAL INSPECTION BY------------------ Date ---'- �` - -•---- - -- - --=--' - 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 Ravised 1,57 FRIZO.