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....... APPLICATION FOR SANITATION PERMIT Permit No. . .p� (Complete in Duplicate) a`/G I v 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. n/� JOB ADDRESS AND LOCATION_ _ �_-c.. ------�_4---...?.ram--�c.:d -------------------------------- .... "- Owner's Name.------. L ' ---------•- ------ `:--------:►_-:_Phone--------------------- ------------ Address........ 1 -7--t t....---- ----- --------------------------- -- -------------------- --------------------------------------------- Contractor's Name---- �---- --- ------------ Phone Installation will serve: Residence Pq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1_.__ Number of bedrooms __7,_o.00.`Number of baths ---/--- Lot sizey------ Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table .1-_,_�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay Adobe❑ Hardpan E] Previous Application Made: Yes E] No � New Construction: Yes No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if rp�ublic sgwer is available within 200 feet.) Septic Tank: Distance from nearest well_C1_ __Distance fr fdation___ 0........Mat ri I_____ -.-- No. of compartments___`-----------Size_3X4rKj.----.Liquid depth...... ' . -Capacity___------ ._ Q YSN L Iv Di sal Field: Distance from near st well__Zm_--_Distance from foundation....1.0........Distance to nearest I t lin ___c7__ Number of lines_____________________________Length of each line_$r' �___ __,Xidth of trench __ _ _ Type of filter material-------------------------Depth of filter matM4�i1, ___ .lengt _ --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation...___.._I......15istance to nearel4ot e___________-____- ' 4 ❑ Number of pits----------------------Lining material--------------•--------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well .________ _-_Distance from foundation--------------------Lining material___ -,_____-_____-___________-____ ❑ Size: Diameter--------------------------------------Dep _ -•----- ----- -------- --,Liquid Capacity-----------------------------gals. Privy: Distance from nearest well________________________________________________Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling an,/or repairin (describe1: _-_ ..� o �- 1 ----------------- 7--—--- .. -- _ ------------•------------------------- --- 1. ' ---- !^t----------- -------------------------- - ... I hereby certify at I hav prepared this application and that the work will be dn accordance wi San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. S( i9ned)-{ ------L--------------''°�--------------- - ---�'-"c�-------------------------------------------------------(Owner and/or Contractor) Tale (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........................................... ----------- REVIEWEDBY------------------------------------------------------------------ ---- --- --- ....... - ----- DATE------.... t r ... --_-----•------- BUILDINGPERMIT ISSUED = --••---------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------- --------------------- ----- ------ ----------- ----------------------- � l 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 FYCO.