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Z,6,6t Z (` APPLICATION FOR SANITATION PERMIT Permit No—13 3---_- (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 with County Ordinance No. 549. JOB ADDRESS AN OCATI ....... --------------- {`J I`' - ------------------------------- Owner's Name / y P ------------ -- Address-----°-2---L_/__P...�- ----- � ------- - -------- ------------------------ Contractor's Name------- --------------------------------------------�----------------------------------------------- Phone.------. -------------- Installation will serve: Resi ence x Apartment House ❑] Commercial F] Trailer Court ❑ Motel E] Other F]Number of living units: _1 _- _____ Number of bedrooms Y/_- Number of baths --I----- Lot size __ __Xth.o---------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [YAdo e ElHardpan ❑ ❑ ❑ Previous Application Made: Yes ISPECIFICATIONS: No New Construction: Ye No FHA/VA: Yes ❑ No TYPE OFN INSTALLATION AND SPECIFICA IONS: _ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se f Tank: Distance from nearest well e-- Distance from fou ation__-.--L_o_____-M teripl-_______- No. of compartments----- _____.__-__Size�.X� . Liquid depth__ _� __-Capacity.___ Dispos I Field: Distance from Weare well--/,-_�9�.Cf ance from foundation____�3_ ,4.Distance to nearest lot he_________________ ` a�L Number of lines.________________________ Length of each line�_ _]�'_ __..___ Width of trench____._ ._._____-____-________ X t l_-----Total length--------/-� ------------------- Type of filter material__,�rt� Depth of filter material--J_8__ _--_-.-- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- M Number of pits______________________Lining material-----------------------Size: Diameter_______________________Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material____--__________________-_--_______. ❑ Size: Diameter------------------------- •---------Depth----------------------------------------------------Liquid Capacity.---------------------------gals. t'V Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________-________________________________- ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------_---------------------------------------------- Remodelinor repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- -- R ---------------------------------•---------------------•--------------------------•---------------•-------------•---•------------------------------- ��.,.� - ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ----------------------------- ----- ----------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, State laws, and rule nd regulations of the San Joaquin Local Health District. (Signeof d) d► N ---------- ---------------------- wner and/or Contractor) By:-------------------------------------------------------------------------------------------------------_ ---------- (Titie)--------------------------- (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 APPLICATIONACCEPTED BY------------------------------ -------------- -- ----------------------------- DATE ------------------------- - REVIEWED BY------------------------------------------------------------- -------------------- DATE------. BUILDING PERMIT ISSUED -- -------- -- •------------------------------------•-- DATE------- '"y----------� Alterationsand/or recommendations----------------- ----- -------------------------------------------------------------------------------------•--------•---------------------------•----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------•-------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ----- ---- ------- --- .......--•-------------------------------------- -------------------------------------------------------------- �. - �, -� r FINALINSPECTION 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 , Revised 1.57 FY.CO.