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-2 (j APPLICATION FOR SANITATION PERMIT Permit No. --------- (Complete in Duplicate) / /1, 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 eLCATION-,- / �*/V Z5 I /I -------------------------------------------------------------------------------- --------------- ---- Owner's Na; ----------------- Phone----------------------- ------------------------- ------------------------------------ ... ------- Address--------- -1 (.2) 1 , -�, -4---- - -----)�:---- ------------------------T----------------------------------------------------.......... ----------------- Contractor's Name---------------------------119-421,1�---I- ------------------------------------------- ------------------------------------------------ Phone------------------------------ Installation will serve: ResidencekApartYnf House E] Commercial E] Trailer Court [:] Motel E] Other E] I--- Lot size ---- �- Ic---------x---- Number of living units: --(----- Number of bedrooms __l__-_ Number of baths Water Supply: Public system Ej Community system YPrivate E] Depth to Water Table :24 ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam El Clayv Adobe E] Hardpan ❑ Previous Application Made: Yes E] No X New Construction: Yes 0 No�, FHA/VA: Yes E] No M/ TYPE OF INSTALLATION AND SPECIFICATIONS: IN, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic_T4pk'. Distance from nearest well.______-_______Distance from foundation--------------------Material------ ------------------------------------------ No. of compartments-------- -------------------------------Liquid depth--------------- ----------Capacity------------- ----------------------------------Si3' ' �iisposal Fiel Distance from nearest well-5pll- stance from fouridafion--I-Z--------Distance to nearest Lot ANumber of lines------/-------- k,e-Length of each line-----04-4- Width of trench--- ----------------------- Type of filter ma -------Total length----X1------- -41(1 ---Depth of filter material-------7--1 - ------------- 04e-e-'p a-g e Pit: Distance to nearest well---------------------Distance from foundation-------------------Distance to nearest loline_____--___-______ F1 Number of pits-_--_________________Lining material-----------------------Size: Diameter___-__-_-..-_____--_-Depth_-_-__-__-________-----_-_--___ Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material____________________________-_-_--__ ❑ aterial-------------------------------------- 0 Size: Diameter------- --------------Dept h----------------------------------------------------Liquid Capacity---- --------gals. Privy: Distance from nearest well-___--_.-_________.____--.- ________-_-_Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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)-X----- D A -, --C, - --- --------- ---------------------------------------------- ---------------------------------(Owner and/or Contractor) By:------I----V---------------------------------------------47\-------------------------------------------------------------------(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 APPLICATIONACCEPTED BY------------- ------------------------------------------------------------------------------------ DATE------------------------------------------------------------ REVIEWED BY--------------------------------------------------------------- --------------------- ......DATE------------------------------ -------------------------- ---------- BUILDING PERMIT ISSUED-------------------------------------------- ------------------------------------------------------------- �2 DATE - ------ --------- ---------- Alterations and/or recommendations:.-------------------------/ ------f��------ ------------------------------------------------------------------•-----------------•-------------------- ----------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------------ ---------------------------- --------------------------••----------------------- ------------------------------------- ------------------------------------------------------------------------------------ --------------------------------------- ----------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------- ------------------------------------- ---------------I----------- --------------- --------* ---- --- --------- ---------------- --------------------------- ----------------------------------------------------------------- FINAL INSPECTION BY------------- ------------ Date--------------x- -------- ----------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 FRCO.