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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) G{ /� 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 +Coffu��nty Ordinance No. 549. JOB ADDRESS AND LOCATION._ .4N�I_-t[J - % Zu-e.t. ------ ------------------ - - -- - ---------- - ----- Owner's Name_-- 5 --- - ------------------- -------------------------------------------------------------- Phone- -- -----{ �� Address------------------------ �� --a''t-- --- Contractor's Name------ -•---------• - __-_ � _-- ----- _ Phone -e --o___��--- Installation will serve: Residence ❑ Ap rtment Hou e ❑ Commercial ❑ Trailer Court [] Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ---Z- ------------------------------------------- Water __Z_ ----- ------------ -----------•------- Water Supply: Public system ❑ Community system ❑ Private-jg—Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [J Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ No72(-`New Construction: Yes12�— �❑ FHA/VA: Yes ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted ifpublic sewer is available within 200 feet.) Se ti Tank: Distance from nearest II �_ Q P -- ----Distance from f dation-- --- ----- ------#!f al--- . ---------•----- No. of compartments_ Size_- r�- *t _____Capacity-,Kx-Sg --5---------- Liquid de thPON p, Dis o$aI Field: Distance from nearest welf-.570----.-Distance from foundation__ ___________Distance to nearest lot line--%57'-"-- Number of lines---.-.a----------------_-------Length of each line_I0__.___ - �---Width of trench--C-.7-,- j4`! Type of filter material_ ---------- _ ' _ �_- --Depth of filter material_____/_ �!----___Total length______-3:��------------------ Seepage Pit: Distance to nearest well_--__________________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------Y-# -Lining material--------_--------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- L1 Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity-------------•-------------gals. Privy: Distance from nearest well----------_-------------------- ------------------Distance from nearest building ❑ Distance to nearest lot line - ---------- Remodeling and/or 7 repairing (describe}:- - ---------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- •---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY$ NIGHT (Signed)----O, ,ng ------Septic T-ank-Serrylice----------------- - ------- - ---- Contractor) By: '=`-----=--------- -----NQ 2.7Q�i6-- ./ (Title)------------- (Plot plan, sizeof Iot,�#�1t9P"tem in relation o ells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- DATE_ ------------------------------------------- REVIEWED BY-------------------------------- -----------I----------- --------------------------- ------------------------------------- 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-4-2M Revised 1-57 F.P.CO.