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00(ga \, APPLICATION FOR SANITATION PERMIT Permit No- ____-D-_ Jam ... (Complete in 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 wit u ty Ordinance Nb. 549. JOB ADDRESS AND LOC TI - Owner's Name------------- / - = ' --------------------------------- -------- Phone----------------------------------- Address------------ -- - ----- - - ------ --------------------------------------------------------------------------------- -- Contractor's Name----------- ------ -- -•- - •-- ---------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence /'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms5�_ Number of baths _:9_ Lot size __ __ __r___________________ i Water Supply: Public system 6 Community system R�` Private ❑ Depth to Water Table 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EnTTardpan ❑ Previous Application Made: Yes ❑ No j9/ New Construction: Yes Zj,-K'o ❑ FHA/VA: Yes Z-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- Distance from foundation__-/_0------Mate�a j_ C____ ____________________________ `! No. of compartments �--------------- Size`;f_d__ _60-- --Liqui��pth--- . ---------Capacity--- --- -------�J----- Dis osal Field: Distance from nearest well_ Distance from foundation--------------------Distance to nearest lot line--- A/ Number of lines---------�-------- --/Length of each line------/7�4--________.Width of trench-------- � -------------- Type of filter mate ria l_/_/_.__Depth of filter material____Z—"/--Total length-------X�___ ___________________ Seepage P• Distance to nearest well-- Distance from AfounAation__Z re..__--_-.Distance to nearest lot line---,- Number of pits-____ ---- ------Lining materialA _fir Size: Diameter_..-_._..__-.___.Depth-___ —Z '� ______________��-�,J Cesspool: Distance from nearest well___.______.____-Distance from foundation__-----------------Lining material-------_------ ----------_-----_..__� ❑ Size: Diameter------------------ -------------------Depth--------------------------------- --------- --------Liquid Capacity----------------------------gals.C-�)). Privy: Distance from nearest well-------------------r-------------------_ ___ __-_____Distance from nearesf building--- ❑ Distance to nearest lot line---------------------------- --------------- ---------n------------------------------- -------------- Remodeling and/or repairing (describe):---------- ----- ----- -- -------- a_ '�cl� 1 �. ------------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------•--•--------------- ---------------- 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 r fes and regula ions of the an Joaquin Local Health District. [Signed}.. ------- '---- - (Owner-at�ct,�or Contractor} By:-------------------------------- -------- -----------------------------------------------------------------------(Title} �� Ll -- -------------- (Plot plan, showing size of lot, tion of system in relation to wells, buildings, etc., can be placed on rever side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- '' DATE-----IS-------------------------------------------------- REVIEWEDBY--------------------------------- ------------ -------------------------------------------------------- DATE ---------------------------------------- BUILDINGPERMIT ISSUED----------------------- �------------------------------------------------------------------- DATE.- ---- --�-------------- -•---------------- Alterations and/or recommendations:---------�--------- -- -----------••--------------------x---�------ µ hi - = ------------------------------------ ----------•-•- --- -------- --•------------------------------------------------------•-------------------------------------------------•------------------ --- - ----------- ------------------------------rte"-- ----- ---------------------------------------------------- ----------------------------------------------------------------------- y - 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 , Revisea 1-57 F.P.CO.