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M7, ,. - - •+- a ,..:? Ir',sa.a .� el-_. �' � - �Zt APPLICATION FOR SANITATION PERMIT Permit No. " (Complete in Duplicate) /4l 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 Co y Ordinance o. 519. 1 JOB ADDRESS AND. OC ;`It! - .. ,. ............. ..---• - Owner's Name ::- . •-•" Phone Address------- -- --15149 -1.---••--•-•- :_ Contractor's Name- ---•----- ....... ••------ -....................... phone.---,..... -•••-•- Installation will serve: Residence Apartment House ❑ Comm:ercial ❑ Trailer Court ❑ 1 1 otel ❑ Other ❑ Number of living units: _:�____ Number'of bedrooms ---V. Number of baths j_;_: Lot size ----- ..........._ __________ Water Supply: Public system ❑ Community system" k Private ❑ Depth to Water Table _7- ft. Character of soil•to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam❑ Clay Loam [] Clay X,Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No I New Construction: Yes No ❑ FHA/VA: Yes❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sew9r is available within 200 feet.) Septic Tank: Distance from nearest well./d.06-[3istance fro foundation___:-_/ No. of compartments-_-__ _-----__:__.S'ze_ % _ _ .;J___Liquid depth -------/_011-- Disposal Field:` Distance from neat weIIQ :4:Distance from foundati n___ :Q_.__.._:Distance to nearest lot lis ...... Number of lines-7.. Length of each line..: 0 yWidth of trench_. _ Type of filtermaterial_J' > CQepth of filter material-------A%_,T_______.Total length_.::.__ ______________________ Seepage Pit: Distance to nearest well......................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_ {? th -- ...... -_-_. Liquid Capacity . Privy: Distance from nearest well-_____ _________ ____________ _______-_'____Distance from nearest building__.__------------- ........................ ❑ Distance to nearest lot line--= -----------------------------------------------------: . ----• ••---,•---• - _-`-----• --- Remodeling and/or repairing (describe):---------------------------------------------------------------._ ._:.._.. .................................... -•---•--• --.--•-• •-_-•-- •••-•--• ................--- ------ -•----- •-•••-- --- - _••••. -•---• -•••-•• -------- ...... --- -- 1 hereby certify that I'have prepared this application and.}hat,the work'will`•be done in accordance with San Joaquin County ordinances, S to ; and,rules and regulations o h San Joaquin Local Health District." (Signed) = �' - = i ----------------------------------- ..._..___...(Owner and/or Contractor] o , (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 APPLICATION ACCEPTED BY..... ...... ...::.......................... ................. - -•--------------- DATE......................................................... REVIEWED BY •-- - DATE BUILDING PERMIT ISSUED------------------------------------------ - --------- DATE ------ -- •_-�_.-• �------- •-------• Alterationsand/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 , Revises 1.57 F.P.CO.