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APPLICATION FOR SANITATION"PERMIT Permit No. (Complete in Duplicate) 7 Date Issued __.___�l .�.� 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 LOCATION_. `1_! _-------- _-_ .... _J_ t1t71_-- 71`-En. .._C%G-.s.K.—.��c- �, , S / Owner's Name----------- !_ s(_ .>iiQ_l_! ------------------------------------------ ------------------------------------------ Phone--------` ......---•------------ Address--------9__'_�__-i....RZ------�-- Contractor's Name _ /—---:__ ___,�1�_�ft �-7%•--_ . etc- ---------------- Installation will serve: Residence P!f_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-- Number of bedrooms _/--- Number of baths _Z__ Lot size ___V7_ //4? -- 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 I2�_ Hardpan ❑ Previous Application Made: Yes ❑ No'fX_wNew Construction: Yes Ej(_No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest w94_P % - __Distance from found ion_J_0_f__-__-__.Material..._ _ t �'Cik -___. " It No. of compartments_-__.d- __. __ Size_ _?�____�O__._.•Liquid depth__S `!______ Capacity....;?0q_ r " � 7-__� Disposal Field: Distance from nearest welL_I7-G�C� Distance from foundation____!___________.Distance to nearest lot line_________________ Number of lines------ -----------------------Length of each line__ ------Width of trench._-_ ..................... Type of filter material. •-_ -_Depth of filter material--____OR..._.......Total length---------YP`___________________•- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.--.----------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----.------------------Depth-------------_-------------_---- Cesspool: Distance from nearest well________________Distance from foundation----_-__----_.__--.Lining material-------------------------- ❑ Size: Diameter--------------------------------------_ Depth----------------------------------------------------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 ordinances, State laws, and rules and regulations of the San Joaquin Local'Health District. (Signed)-.—. l F L = Contractor) ?: BY: ------------------------------------------- j (rtle)----------------------------._. -- - (Plot plan, showing size of lot, location of system in relati to wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- Z — DATE------ ------------------- ------------------------ REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------ ----------- BUILDINGPERMIT ISSUED----------------------------------------------------------------- •------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------- -------------------------------------------------------------------------------------•----- -------- ---------------------------------------- --------------------------------------------------------------............................................................................................ ---------------- ------------------ -----------------------------•------------------------------------------------------------------- --•---------------------•------ ----------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r 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 FP.CO.