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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 315^� 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. -A� r JOB ADDRESS AND LOCATION___ •----__--__-_ A��_4_4,e Owner's Name___-. - --- - Addresst'� .�1�"r'1 --------------------------------------------•----------••----------------------------------- Contractor's Name__�C- �,, _ _ - -�,4 1. _ .FB!-7 ------ ----- - ----- --- -07�----- --��-- --�------ -�,�4------------------ Phon ------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Tr ler Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms _3___ Number of baths Lot size ------1____ ! ''_________________________-_______ Water Supply: Public system ❑ Community system ❑ Private Z Depth to Water Table ad__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam j] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No �r New Construction: Yes JX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 7.1 Septic Tank: Distance from neatest w6l__4;�T----Distance from. foundation__/_6----------.Material---________.__-__ ______________ No. of compartments._, ._--- -}______.__Size__ �t-'r_q' ___ ____-Liquid•depth__.__--f________________Capacity_/ G' Disposal Field: Distance from nearest well_S_A-------Distance from foundation__-_( ---------Distance to nearest lot line___r____-___ Number of lines---------;-__._____--- _____ Length of each line______�a_----------------- Width of trench----7r_4_ ..........I--------- Type of filter material -AW-Depth of filter material__1 '---_----_.__Total length--- Q__�_ _____________________ Seepage Pit: Distance to nearestwe I----------------------Distance from foundation-_.-----.___..._..Distance to nearest lot line----------------- ❑ Number of pits.---------------------Lining material----------------------�Siz�e: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--______-_________-__________-___-_. ❑ Size: Diameter----------- ---------------Depth----------------'--�-----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________________________ ____________'rDistance from nearest building------------------------------------------ F-1 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 ,�lr �„ --- '•--- ---------------------------------------{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). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-,;A -' _ �---------------------------------------------------------------- DATE__ I REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED--- ---------------------------------------------------------------------------------------------- DATE------------------------------ A[ferafions and/or recommendations----------------------- --- ------------------------------------------------------------------------•-------------------•--------------------------------------. --------------------------------------------------------------;.;'/' ------------- -------- -------------------------------------------------------------------------------------------------------------------------- -----•---------------------------•-•- - - ---- -- ----------- ---- -- -- ---- -------------------------------------------- - -----------------------------••------ ---------- FINAL INSPEC BY--- - ------------------- - ----- ------ Date-------� ----------------- f ------------------------------------------- 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-