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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S _. / -7 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 complian with County rdina e No. 49. L.c7 GSE. �✓J�" JOB ADDRESS A D L ATI _ _____-_-- ----- 46.t Owner'sN ' r --------- --- -- ----------- Address____- on -- - ---- ------- ------- ---------- -- Contractor's Name________________ ____ - ----- - --- --- -- ❑ ---------.- Phone---------------•-- -- -----•-------- nstallation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motfl ❑ Other ❑ Number of living units: - _ Number of bedrooms ---Z. Number of baths L___ Lot size Water Supply: Public system ❑ Community system Private ❑ Depth ater Table _______ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay El Adobe E] 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 ifpulalic se r is available within 200 feet.) Septic ank: Distance from nearest well-r+'U st c prom found n-----1.0-•___. aterial__ No- of compartments______ - _--- ' e -- ------ ____Ca acit iquid depth p Y.. QQ ` Disposa reld: Distance from nearest well_._ ___. - _ istance from foundation/4 'stance to nearest I t li r E Number of lines------ ----- T �- ----�gth of each line_____________ � Width of french_____11A__. _ f Type of filter materia_ - th of filter material_._.__-- .-__-----Total length----------(--- _ _--__------ --- Seepage Pit: Distance to nearest weir____________________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 Privy: Distance from nearest welt___ Depth Liquid Capacity G ---------------- -----------gals. ________________________________________._.-Distance from nearest building ❑ Distance to nearest lot line___________________._____ Remodeling and/or repairing (describe)_________________________________ P - t> •----•------------------------------•--------------------- --------------------------------------------------=------------•-----------------------------------------------------------------------------------•------------------ ------•---------------------------------- 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}_____ _ -__ ice•{ _-.------_(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 APPLICATION ACCEPTED BY___ -- DATE_ -------------------............................... VIEWED BY--- -- - - UE------ ---- ---- - -------------------------------------------------------------------------------- DATE WN BUILDING PERMIT ISSUE------ ------- -- ----------------------------•-------------------------------------------------- DA7E. -------------------------------------- Alt ratios and/or co gfiendatio s: ----------------------•--•-----•----•- �. y a g, . - �- ------------------------------------- ----------------------------- FINAL INSPECTION BY. + ------------------- Date---- � , _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21ARevised 1.57 F.P.CO.