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APPLICATION FOR SANITATION PERMIT Permit No. ------- (Complete in Duplicate) Date Issued - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r`s'his application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION _4------ ------a-1------------ -------------•---•----------•-I----•-------------- Owner's Name f4�n�ih1----- � *t4-----------------••--------------------- -------------------------------------- -- -- Phone--------- OS -- Address---------------- �--- --•• `�� ------- Contractor's Name +— Phoned ._--3 ------�S _S �- Installation will serve: Residence F--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I__ Number of bedrooms .!*?- Number of aths ---f---- Lot size ------------------------------- Water Supply: Public system E] Community system El Private Depth to Water Table 1:9�_ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam El Clay El Adobe ❑ Hardpan ❑ Previous Application Made: Yes F1 No �ew Construction: Yes Rl"'No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: • (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic T nk: Distance from nearest well-----------------Distance from foundation--------------------Material______-________.______-_----____________________- No, of compartment-s--------------------------Size---------------•----------------Liquid depth--------------------------Capacity------•------- ------- DisposAR'1: Distance from nearest well-----------------Distance from foundation______________-____-Distance to nearest lot line______________-Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material______ ----------Depth of filter material-----------------------Total length___-__________-___________________________ ��*r' Seepag Pit: Distance to nearest well - Q_4_-______._Distance from foundation--- 41 _..Di;tar;�e to nearest lot lie_---------------- L _g ___._____ Number of pits--__j________________ ining material_A/"tA,-_____--_Size: Diameter__.__4/_!&-------- Depth--- ---- ___------------------ Cesspool: Distance from nearest we11--------------___Distance from foundation--------------------Lining material______----______-_____--_________-___. e—N ❑ Size: Diameter------------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 'rivy: Distance from nearest well___---------------------------------------------Distance from nearest building__----------_-__________-___-_-___--___. ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------------------------ ------ t Remodelin and/or airing [d ribeJ:_----.__._�' "' -----t= �/- ---- f -- ------ ------�------------- �J f --------------- = -- -- - - - ! �ereby certif that L'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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ` -------------------I--------------------------• DATE.-,,X,,,,,, --------------••-------------- / ,.. 4 , .jl; '60 i �. .ge' ' DATE �` REVIEWED BY--------------------------------- t -----`- ----•------•------- BUILDINGPERMIT ISSUED---------------)--------------------------•------------------------------------------ ------------- DATE._--- --------------------------------- Alterations and/or recommendation�------------------------------------------------- ----_----------------------- ------------------------------------------- ------------------------- ----------------- ------------------------ _______•_________________R________----------------- ___________ _ _ _ _ ---__-_______-___-_______-_-____-____________________________________________________________-____.______._______._______.______._____.________.______ -- ----------------- - =-I- : `''----- ----------------- ----- = ------ ig __!T ------------- = ' ��FINAL INSPECTION BY:--------- ------------------------------ Date------7-1,3�-1� 1 -------------------------------•---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strea+ 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California r� ES-9-2M Revises 1.57 F-P.CO.