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7-3 APPLICATION FOR SANITATION PERMiT Permit No. ----. F ................ (Complete in Quplicatel Date Issued 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. JOB ADDRESS AND CATION.. ---------------------------- ---------- ------------------I-------------------I"1,16e,___------------------------------ Owner's Name---------T �,1� _ -------------------------------------------- Phone------------------------------------ Address------ ------------------------ ----•-- Address-_____ , 4KS Contractor's Name--------------------------ra-1 ------- ------------- ----- ----�-� �---------- ------- --•- •- -�----•- - � -•-- -------- Phone- -----....----- --- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_. Number of bedrooms _. Number of baths __/-/__ Lot size __/ 75 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table,r__d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No p-- New Construction: Yes [g- No ❑ FHA/VA: Yes ❑ No [q--_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ' ' ,(, Septic Ta : Distance from nearest well.' d._______Distance from foundation--.1Q____.____.Mat�iai_..--�-�___.__!� C"� No. of compartment-s_.....-�.-- ----__-_-Size__S__�-Y'3_6--_.---Liquid depth___--�__�r.-------__Capacity------0 0 Disposal Fi lcl: Distance from nearest well__`_'4------- istance from foundation--- -----.Distance to nearest lot line___.S ----_ [► Number of lines_______ _____ __ Length of each line--------�_s�_��_____.Width of trench------ -r7�.��--------------- n Type of filter mateal_S!__ P_C ',_Depth of filter material----.1-r---------_Total length--_; ----------------------------- Seepage Distance to nearest well_-)64----------Distanc om f undation...yd-------.Distance to nearest lot line----------------- Number -_ s_----.-- Number of pits-_/---------------Lining material__ __ ____._._._.____._Size: Diameter____ _ ___ ______..Depth__._ _S................... 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 kne----------------------------------------------------------------------- -------------------------------------------------------------------- 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 Cou ordinances,Ma,,fe laws, and rules and regulations of the San Joaquin Local Health District. (Signed) f "` % 4 -`-----�--------------------- ------ (Owner and/or Contractor) ------------------------------------------(Title)-L `-- ----------------------------------------------- (Piot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •--------- -------------------------------------------------------------------- DATE---------------- -------------- REVIEWED BY--------------------------------------- - - DATE-- r BUILDING PERMIT ISSUED------------------- - -----------------------------—-----------------------------------. DATE---- - ---•-------------------•---- Alterations and/or recommendations--- - - ----------------------------------------------•---•---------------•----------------•------•-•-------•-------------------------------------------•--•- ------------------------------------ '_ f - ---------------------------- - -- - ------------�- -------------------------------------------------.----------------------------------------------------------------------------- ----------------------------- ---------------•--------•---- - - -------------------------------------- FINAL INSPECTION BY:------ - - _�---------------------------------- Date--- /--------- - - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1.57 F.P.CO.