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Z E APPLICATION FOR SANITATION PERRIT Permit No. (Complete in Duplicate) Date Issued ._. .y.......-, . 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 OCATION-_JS - ------------- B-174-F------- -------=------------------- o --- / ------------------ Owner's - --. -_-. Owner's Name.------- -. - '^ __---- _. Phne Address---- , r......... . -- . Contractor's Name---- -----_ - -----------------•---.. �Pne................................................. ..._....... Installation will serve: Residence ;Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ .______ Number of bedrooms __._�_._ Number of baths J.... Lot size _.,.�""� X._ _n_D_._. Number of living units: 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 k Adobe F1 Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes� No ❑ FHANA: Yes [:1 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or'cesspool permitted if public sewers available within 200 feet.) Sep i Tank: Distance from nearest well__ _ /1 � +'"' fr foundation Mate ia); _C " .�Q'... No. of compartments Size.T_ �._ Liquid de th_______ _1 Ca acit �r P ��j�� q p. p Y R-. ; Disposal Field: Distance from nearest well-Y+- " iS1"ance from foundation---/I Distance to nearest lot'liine./& Number of lines.____-__�___: _"______-_ Length of each line____ G!_�.___ Width of trench--____Ae.0 Type of filter material- - P Depth of filter xnaterial____A �f___:_.__Total length___.._.�D_�Q_ _ _________ ___ Seepage Pit: Distance to nearest wel----------------------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 Ca_P cit}----- -- gals Privy: Distance from nearest well----------------------------------.--------------Distance from nearest building....................................... ❑ Distance to nearest lot line------ -------------- -- ---- --- ------------------ --- ....................... --- -----..................... Remodeling and/or repairing (describe):------- -------------•-•---------- ----------------- ------ •----•. --•--•• ----.•. -•--- -. ..--•••- -----•- -------------------------- i..............• - -----•---- --- ----------------------•-------------- ---------------------•-------------- ------ --------- ----------------__---- --•-----•-•------------------ - 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 atW regulati s of th San Joaquin Local Health District. (Signed) f•, --- ------------------------------------------------------------------------ -(Owner and/or Contractor) (� - -----(Title)-------------- -------------------------_---------------- (Plot _---- •------(Plot plan owing size of lot, loc on system in,relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------- -- _- ---------------------------.................. DATE------.....................................--------------- REVIEWED BY------------------------------------------------------------------- - ----- -- --- ----- - DATE..... �f . BUILDINGPERMIT ISSUED----------------------------------------- - --------- .............. DATE............................ �:. A teo an ecomme or 04.0 10 ------ ---------- •. -•-------- ----------- ---- ----------------• - ------ ---- --- •------ -• -- ------------------------------------------------ --- --- FINAL INSPECTION BY:--------- ------- --- _ --- ----- Date----------------------------- -------------- SAN ---- --------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.