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*,1 APPLICATION FOR SANITATION PERMIT Permit No. - . .3....--.... (Complete in Duplicate) Date Issued Application is is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ d. This application is made in compliance with C unty O dinance 549. JOB ADDRESS AND LOCATI N---- 60 Owners -----••--- `-------------------------_------------------------_-------_ ------- ---- ---- ------ Phone------------------------------------ Address----- -----------------------------------Address----- ---------- � Contractor's Name p-40--- -- z�� r Phonei ------ - 7-= _� ---- -- - -------------------------- ----------------- - Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --t---- Number of bedrooms _;7--,- Number of baths ___I___ Lot size ---1/16-41-12r-7 Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table _30_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam tZ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weU_- ---- Distance from �. foundation___/_Q__________.Material_--------_ __ ___________ ------------------Ca acity ��gNo. of compartments_______----------Size------. x Liquid de th____ Disposal Field: Distance from nearest well--(5-V-------Distance from foundation---ld---- ------Distance to nearest lot line-ir_�,________ ® Number of lines-----------2_------------------Length of each line------,3n__--- --------.Width of trench --------------------- Type of filter material-----0?Ae/<_____Depth of filter material __._/A---__---------Total length------- i A=(;tf: Distance to nearest well_U`'_------------ Distance from foundation___.ZQ..........Distance to nearest lot line__43`�____-___ 21 Number of pits---------!------------Lining material----------?a-6/(---Size: Diameter___' 1______Depth___---------------------------- Cesspool: --____ __________________Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------- __-__________. ❑ Size: Diameter--------------------- ------ ---------Depth----------------------------------------------------Liquid Capacity- - - ---------------------gals. Privy: Distance from nearest weft_______________________---------------___------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line_ ---------- ---------------------------------------- -------------------------------- -------r---------------------------- Remodeling and/or repairing [describe]:---- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------•---------------•----------------------------------- 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 r les and regulations of th San Joaquin Local Health District. C (Signed)- ------ -- ------ ---- -- ------ -- 0--(------------- --------(Owner and/or Contractor) By:--------------------- .------------------- -------------------------------------------------------------------(Title)-------L,--f2�-------------------------- (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 T_ ---- --- ---- --- -- -- ---------------------------------------- DATE------ r - REVIEWED BY ;- ------ --•---- - ------------------------- DATE------- � /- -= BUILDING PERMIT ISSUED -. - -- -- DATE ---- ---------- ------------------------ Altera on and/or recommendations:--------=- ------ ---- - ------------------------------- _•�� ---_- --• - ---�--- :::: ---------------- ------------------- : ---------- ---------------------- ---------------------- -------------------------------------------------------------- ---------------------------•--------------------------------------------- --------------------------------------------------------------- ---------- ----- - f - FINAL INSPECTION BY:---J �= /- 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 E5-9-2M Revised 1.57 F.P.CO. i