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APPLICATION FOR SANITATION PERMIT Permit o. -1 's=--- (Complete in Duplicate) G Date Issued -- -------- Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CAT-I_O_YfN�__�_. E -------- /_ -------------------------------------•-------------Owner's Name_ ---------.-- Phone_- Address!_---......... _. 1T -��Q— `^� r ------------------= - ------------------------------------------------------ ------------ Contractor's Name l -----!� - -'� lN_- /- ---------- ----- ------ Phone. 4 Installation will serve: Residence [;/ Apartment House ❑ Commercial Til I i ❑ raer Court E] Mal E] Other E]___ Number of living units: -__ Number of bedrooms _Number of baths I--• Lot size sy5- ------X' - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabl ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo m ❑'Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No !_7 New Construction: Yes' o Ej FHA/VA: Yes F-1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) a t Septic Tank; Distance from nearest well_-- ------Distance from Joun&ion-___-/Q-------.MXvial... __...______--v±�_wY �f No. of compartments----__-_�'.._.`_Size__e_3X,( _X_,W____--_Liquid de th______ (�G ` _____.Capacity.__ ----------- Disposl Field: Distance from nearest well__---_Distance from foundation__ __�---Di�tance to nearest lot line__._____ j [� Number of lines___________ _ _____ _ Length of each lne _._-+--5,�j ;dth of.trench_� Type of f_ filter material---� ----Dep#h of filter Material g -- ------.Total length ------------ ' Seepage Pit: Distance to nearest well----------____________Distance from foundation--------------------Distance to nearest lot line-------____-___.- p ❑ -`-Number of pits.._. '"' ""Dining material-----------------------Size: Diameter----------------------- IV ------- Depth---------- -------------, - r - Cesspool: Distance from nearest well----1---- --_Distance from foundation------------------- Lining material--_____- _.................. ❑ Size: Diameter---- ----------------- -------Depth- - ------------------- ----------------------- Liquid Capacity--------------------- ----gals. Privy: Distance from nearest:well____-----------------___ _______________________Distance from nearest building------------------------------------------ ❑ Distance to nearest lot,line = -=-------------------------------------------------------------------------- 1 -------------- i 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 rules and' 'reg Lila tions of the San Joaquin Local Health District. (Signed)-- G - e'L �� ; Owne nd/or Contractor) BY: (Title) _--------------------- -•------------------------------------------------------------------------------------- . le)------------------------------------------- (Piot 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----- REVIEWED BY--, -------------------------------- - ---- ---- ----------- ------------------ -- J�----------- -------- --- ------------ DATE----- � BUILDING PERMIT ISSUED------------- ------------------ ------------------------------------------------------------ 4 DATE---------------•- - ----------------------------------- Alterations and/or recommendations:_-__------------------------------ -* - if---- 5 ff (� _ ---------------------------------•---------1---------------------�-------------- --- - - ------------------------------- 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 E5-9-21v1 , Revised 1.57 F.P.CO. el