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4 APPLICATION FOR SANITATION PERMIT Permit No. ..�___.__l_-.__-1-.-.- (Complete in Duplicate) Date Is;ued 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. r i;: � s� I ry -trr �-c-� ((`` '1 JOB ADDRESS AND LOCATION------.--,a',41 s '+ ___+1` _.----51.-- __ ►,uY.-_T- Iu j: Owners Name- t : ----------------- Phone------------------------------------1'--`' Address-------------•---------------------- - '' i EE ----------------- ll------------- Contractor's Name--------------••-------•------1 -_: w_.. ` \ it\-4. X _. 1'� ` r° ------� - - = -- -�--- - -.-�--------------------- Phone------•------ Installation will serve: Residencie Apartme�n` House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L.---- Number of bedrooms 3-__ Number of baths--- Lot size _-_ -- '-�-------------------------------------- Water Supply: Public system ❑ Community system ❑ Private 5aDepth to Water Table _J✓-Lft. Character of soil to a depth of 3 feet: Sand/ Gravel E] Sandy Loam E] Clay Loam ❑ Clay p Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nox rNew Construction: Yes No ❑ FHA/VA: Yes ❑ Not TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r Septic( Tank: Distance from nearest wel__2A1^-r_----_Distance from foundation-_-V Lf__._--.__.Material____-(_ u! r� * ---------- No. of compartments------- ------------- depth---------7 --------_ Capacity-----_ 171:L--. l � • f Disposa) Field: Distance from nearest well_7----------.-Distance from-foundation----20-r------.Distance to nearest lot line------------------ Number -- -----------Number of lines-----------/---------------------Length of each line------- ------------Width of french-----2-_%`_te------- - Type of filter material-_---Q_,c>__�__,______Depth of filter material_----�-Y-"'---___.-Total length------ ---------------------- 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 material-------------------------------------- El .-.---- -._----._-----.❑ Size: Diameter-------------------------------------Depth------------------------------ --- ------------------Liquid Capacity---------------------------gals. 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, Statelaws, and rulesan,d`re_gulations of the San Joaquin Local Health District. +�" t "'-"--- (Signed)---- �-1------ � � - -1 ---------------- -- - -- ---- --- ----------------------------(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 _, ti, APPLICATION ACCFPTED BY------ ��.t_ i w :- ------------------ ---------------------------------------- DATE------`,'� C 3 -- - --------- REVIEWEDBY---------------------------------- - ---------------------------------------------------------------------------------------- DATE------------- - ----•------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations----------------------- -----------------------------•-•---------------------------------------------------------------•------------------------------------ FINAL INSPECTION BY:-._.��_ _ __ ------------------------------------------- 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 Revises }.57 F.P.CO.