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APPLICATION FOR SANITATION PERMIT Permit.No. ...1 ..o (Complete in Duplicate) Date Issued This Permit Expires I Year From 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 LOCATI N - --- ---� � Owner's Name---------- -- ----- ------------------------------------------- Phone------ ----------------------------- ' Address------------ 1 �,. y---- --------- --- ------------------------------------------------------------------------------------------------------------- Contractor's Name__�2's_:u--------------••-•--•--------------------------•-------------------------------------------------- ------ Phone--------•••---------_--------_- Installation will serve: Residence,} Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms �-►7__---- Number of baths ___(____ Lot size ________ J__________________________________ Water Supply: Public system ❑ Community system ❑ private W Depth to Water Table :ZP ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 4 Clay Loam I] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No R1 New Construction: Yes ® No ❑ FHA/VA: Yes ❑ 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---"r0_ Distanc fro foundation-----1 , Material-_ ------------------------------- No. of compartments____.-------------------Size__ 't- - 'r___s-----Liquid depth----u-------._----------Capacity...j-Yd�---7 Disposal Field: Distance from nearest well---G...--------Distance from foundation----1_0�_------Distance to nearest lot line________F_-_---- Number of lines---� --------__Length of each line_-��.'----z'�:_Width of trench----- _---- -------- a Type of filter materia� .__Depth of filter 7------------ length __._____,- Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------.-------.Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material-•---------------------Size: Diameter-------.---------------Depth-_------------------------------- Cesspool: Distance from nearest well_______________Distance from foundation___________________ Lining material-_____._.._.---._____________-__.__. ❑ Size. Diameter---------------------- --------------Depth-------------------------------------- -------------Liquid Capacity---------------------- 9alS. Privy: Distance from nearest well_______________________________________._._---Distance from nearest building---___.________------_______________-.._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------ ----------------- -- Remodelingand/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 Local Health District. (Signed) ----- ----------------------------------------------(Owner and/or Contractor) By------------------------------------------------------ ------------------------(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-- - • -- --------------- ------------------------------------------- DATE----' 777 -7--'(' ------------------------------ REVIEWEDBY--------------------------------------------------------------------------------- -------------------•------------------- --- DATE-------------------•--•------------------------------------ BUILDING PERMIT ISSUED------------- �}� DATE------- --------------------------------------------------- Alterations and/or recommend tion :- -------- -- L:��"_ ' l --- --------------- ---- -----•------------------------------------ - -------- ----------.-_------------ -------•--------------- •------ -- - ----------------- FINALINSPECTION BY:---- -------------------------- --------------------- Date-------- -------- -_�.--- - 0----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ockton. California Lodi; California Manteca, California Tracy, California ES-9-2M Revised U59 F.P.Co.