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._ . 3..�. r � APPLICATION FOR SANITATION PERMIT Permit No. ,� -- 1 t (Complete in Duplicate) Date Issued ---y/ 6..a 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. / d . JOB ADDRESS AN LOCATION I_ l7 Owner's Name------ y . ......... ----------------- Phone----------------------------------- ---------- Address-------+ j----- - --- ---- - ------- j -- l�� Contractor's Name..........� ------- ---- -- -- ------------- --- Phone----------------------------------- Installation will serve: Resident [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms ----I--- Number of baths _____1__ Lot size ________________________ Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table W. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay { Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes X No ❑ FHA/VA: Yes ❑ No EX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public s w r is available within 200 feet.) Septic Tank: Distance from nearest well _ _ ._ nce from oundation____-1-.0?_-___.Mater' I-f_� _ 9, No. of compartments-______y[__.. ---Size..... __,e ._ quid depth_..-__-_ eapacity_.__ _47C2..... Dispo al Field: Distance from nearest well ante from foundation____/0--------Distance to nearest lot li`j-__.,r___-__- Number of lines________I____-____ Ype of filter mater -- p Length of each line........ .U___ Width of trench._._�►t_�_-____________________ T ial___cs _ _ e th of filter material___.-_.-_ ----- Total length..__..2-�__________________________ V �--- 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---------------------------------------Depth----------------------------------------------------Liquid Capacity---------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________--____________________________--. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------- -------------------------------------------------------------------------•--•------------------------•------------------- -•-•---------------•-----------------------------------•-------------------------------- --------------------------------------•-----------------•-------------------•--------------------------------_-_- 17 Q -------------------------------------------------------------------------------------•---------------------------------------------------- -------------------------------------------------•---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stas, and rules and regulations of the San Joaquin Local He Ith District. (Signed)....... "t'__._ Q ". r_-- � .� (Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------- ----(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--------------------------------------------- ..000e- -------_---------------- DATE--------•------- /j -•---------- REVIEWEDBY----------------------------------------------------------- DATE f 4C� 6 ......--------------- BUILDING PERMIT ISSUED-------------••-------------••----- ---------------------- -•-- ------ — DATE Alterations and/or recommendations --------------------------------------------------------------•-------------••--------•--------------........................ ---------------------•---------------------•---------------------------------------------------------------------------------•----------------------------------------------------------•---------•---•-•-•-------------- ---------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------•----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------ ---------------------------- ------------- ------------------------------------------------ ------------------------------------------ ----------------(----- -------------------------------------------------------------- FINAL INSPECTION BY:----- ------ Date-----------_ 1-_ - 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.