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APPLICATION FOR SANITATION PERMIT Permit No. _.1. L. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued bate issued ../O/-_d_-___ �r7- 2-&6--3t'Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descn d. This application is made in compliance with County Ordinance No. 549. j�CC��t L-a-je-f A F-4 d D �4-✓�- I j A ADDRESS AND LOCATION_...__ - 6,��r�Q---- g=----�--�- -�-'�4t-- -�--- ---- Owner's Name----------------- ___ Phone---------------------------- Addressan__ii ------------ Contractor's Name------------------------------- Phone------------------------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑, Trailer Court ❑ Motel ❑ Othther ❑ Number of living units: /----- Number of bedrooms ` Q _ Number of baths __�� Lot size __---x -------- ----- D.-------_________.----•- Water Supply: Public system ❑ Community syste �rivate E] Depth to Water Tabled-7t. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [] 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 sevmr is available within 200 feet.) _ Septic yank: Distance from nearest well_-S,Q -__-.--Distance from found ion Ago—. Material-----dr .-i______________________ No, of compartments-----Z__-______E__-.__rSize,1O ._-___Liquid depth_--_--�1---------------Capacity_14�-O.d_- Disposal Field: Distance from nearest well-6_i0�^"�3istance from foundation_AOnr �-_. istance to nearest lot Number of lines_____________ __ Len th.of each line__________ Width of trench-__ _- -- __---------- Type __ - _ Type of filter material--- epth of filter material___.Ag� -------Total length___- --------------------- ` Seepage Pit: Distance to nearest well----------------------Distance from foundation______-__--_•___.Distance to nearest lot line__.__.________--_ ❑ Number of pits----------------------Lining material------------- 6ize: Diameter--------------.--------Depth-.----.-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation____.--------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth--------------------#-----------------------------Liquid Capacity----------------------------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 and regulations of the San Joaquin Local Health District. (Signed)--------- - --- ------------------ ------------------------- ---------------------._.(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). FORD ,R EN SE O Y ff APPLICATION ACCEPTED BY------ A4 ------ --- DATE- / - -4P REVIEWED BY--------------------------------------------- -------------------- ---------------------------------------------------------- DATE--- ---------------- ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------- ------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:-------- ---------------------------------------------------------------------- ------------•-------------------------------------------------------- ----------- ----------------------------------------------------------------------------------------------------------•------------------------------•------•---••--•----•---•-----•------------------------------•---------- -------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- - ---- - - ----------------------------- -------------------------------------------------------------------- ----------------•----------------------------- - --------------------- e HNf+,L INSPECTION BY:.- ,Ix Date Ad eAt-d- �4--� 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-92M Revised 8-'S9 F.P.Co.