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Fn I S� re 5,+ APPLICATION FOR SANITATION PERMIT Permit No. /.U...`� (Complete in Duplicate) 7 pate 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. [,ev- �Ff a JOB ADDRESS AND LOCATION41J.•r _-- - -_- .............................................................. Owner's Name..........I - --- --------------- Phone..............------.............. Address....................ods 3. r- ------..........................-- ....... f- Contractor's Nam __ f_ t .....xG-_7�7-------- ................................................... PhoneiW. ,7�, ! Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3- ----/ia-`-----•----•----- •. Number of living units: __ ._.._ Number of bedrooms __yNumber of baths .__..__ Lot size __ __._..__ � ._ _ Water Supply: Public system ❑ Community system 'Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay Adobe Hardpan ❑ Previous Application Made: Y-o 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_19Distance from foundation_/4-----------Material 19-1 No. of compartments_---- Size.a o_�`.3.r �'__.-_Liquid depth__"- 7-_ ..____..aaci .��__+�___.. Disposal Field: Distance from nearest well. 1 —`-__Distance from fou ation...1-,?;;-`_.._...Distance to nearest lotline...."?.=- Number of lines___!1� _ Lengthth of each ----Width of trench----Z Tpe of filter matenaL -_--Depth of filter material --------Total length___ 46_0 _------------- Seepage --_____.__...See a e Pit: Distance to nearestwell------------- --------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--------------------.......... � ❑ Size: Diameter--------------------------------------Dept h-- ----------------------------------------Liquid Capacity--- •-- -------------gals. Privy: Distance from nearest well---------------------------------------__________Distance from nearest building___ ___-- - .......-------_-__. ❑ Distance to nearest lot line--- - ----- - ------ ------ - -- --- •- --------------------------•---- Remodeling and/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 ordinance State laws, and rules and regulations of the/SanJoauin Local Health District.(Signed.._ ! - /1./_--- __ � si�C� � --�M Contractor) By: ----------------------------------------------------------------------- �----------- -----------------(Title)---------------------•------------.....------------ --------(Plot plan, showing size of lot, location of system in.relatils, build' gs, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- ------- - --- -- - ------------------------•------------------------------- DATE------ - REVIEWEDBY---------------------------------------------------------------------------------------------------------------------- ------ DATE------ • BUILDINGPERMIT 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-9-2M , Revised 1.57 F.P.CO.