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APPLICATION FOR SANITATION PERMIT Permit No. .G .. ......... (Complete in Duplicate) !�Date Issued __/----l � _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins#ail the work herein described. This application is made in compliance with County Ordinance No. 549. p JOB ADDRESS AND LOCATIONQ ----+0-2=------- ---- ....- ---- Owner's Name------ J --------------------------------------- - -- Address Address 1 ... `J--�----------_---------• ----------- Contractor's ---•----------------------------------------------------------------- --- ... Contractor's Name_____ r ----' "- ---___?.--T.______ ---------------------------------- Phone7�_4�� -- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ________ Number of bedrooms -------- Number of baths -------- Lot size ________ - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft, Character of soil to a depth of 3 feet: Sand p Gravel E] Sandy Loam ElClay Loam ElClay E] Adobe_D�'Fiardpan ❑ Previous Application Made: Yes ❑ NNew Construction: Yes ❑ NoCE( 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 well_NCW&__Distance from foundation__ ____ ________.Material--- n No. of compartments----��___._ '___......Liqui depth__-�e-.__.----------Capacify_.R _______-_. �J is spos�l Field: Distance from nearest well-1x4�+�T___"Distance rom foundation„ _._______.Distance to nearest lot IinecQ_�_. Number of lines___.____ ______ Length of each _______________Width of trench_A;9_54P__------------------ Type of filter material_ r Depth of filter material-----/ _____Total length �____________________r__ �!�_ Seepage Pit: Distance to nearest well__N0k.a --------Distanceom foundation__ff..--------Distance to nearest lot line__/�_____. (� Number of pits__ _______________Lining material___ oe . __.Size: Diameter___�__�-_13 --------------- � `�3 Cesspool: Size: Diameter_______________Distance from nearest wel€-----------------__________"- p Distance fro found _ ation___-_________._____.Lining material__.________________._______________. ❑ -" ------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------- ----------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line-----------------------------------------------------------------------------------------------------•----------------•----------------------- Remodeling a d/ r repair' ck(describe):-- - ------------------------� ----- --- - ------ - -- ------------ ------------------ ------------------------------------------------------7---------- --------__------------------------ --------------------------------------------------------------------------------------------------- - ------------- ---------------------------------------- ------------------------------------------ ------- ------------------------------------------ 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 nd regulations of the San J in Local Health District. -------------------- Contractor r--- By--------------- ------------------------------------------ -- -- - --- ------ -----------------------------------(Title)---------------------------------------------- ------------- (Plot plan, showing size of lot, location of syste in Iatlon to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ -------- ---------------------------------------------------------- DATE------------------------------------- ----- REVIEWEDBY--------------------------------------------------- ----------------- DATE •---- --= = BUILDING PERMIT ISSUED---------- ------------- I- --- -- --- --------------------------------------------------- DATE----- ---- Alterations and/or recommendations:---------- --------------------------------------------------- •------v -------------•_.._..._.... - ----------- ----- ------------------------------------------------------------------------------------------------•----•- A� - --------- ---- -------------- -------- ----------------------------------------------- ---- -- --- - -------- ---------- ---.-�- FINAL INSPECTION BY:- Date -~---- ------------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore $free+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F,P.CO.