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P/ APPLICATION FOR SANITATION PERMIT Permit No. __A2...el,�_ (Complete in Duplicate) Data Issued ---/L-��-�- 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 LOCATION_ , ---------- - Owners Name------------- -------------------------------- ------------ Phone--------------------------------- Address------------------- - -------------- - -- -- -- - ----------------------------------------------- Contractor's Name-------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial frailer Court ❑ Motel ❑ Other ❑ Number of living units: _'� Number of bedrooms ------Number of baths A0'__ Lot size ----------------_------ � � I Water Supply: Public system ❑ Community system ❑ Private Wo"bepth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe f�ardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes Aj-'T-�o ❑ FHA/VA: Yes ❑ No [r—' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well_-!_ __Distanc from foundation Ma I----___-___-_-__-_--------_------..- A-� // - -------- 2.r [7�� No. of compartments-.0 . � J q g p .CapautY LBt� f' ' Disposal Field: Distance from nearest Distance from foundation__%T_� --.Distance to nearest lot line--IAO---------- �. �" Number of lines----_---;�i---- -------- - Length of each line_-��--------_------.Width of trench___,4_/f .__..-----_- . } Type of filter material-_ Depth of filter material----I - // ------- Total length----��--�---------------------- ----------- • J Seepage Pit:- Distance to nearest well-- 440-_-, __Distance from f ndat:on___-_-- - Distance to nearest lot line--- -- ---- �L ®� Number of pits-_-Z------------Lining material-�--.Size: Diameter--a.?- -------Depth--- - ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-------------------------_____-___-. 1771 Size: Diameter------------------ -- Deth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------- -------------------------Distance from nearest building-____---._------_-----____--------- ❑ Distance to nearest lot line--------------------------------------- ----- ---------- ------------------------ Remodeling and/or repairing f describe):----------- _-_--Zfliont - ------------ _-__ _______ f ---------- ------------------------------------------------------------------------------------------------------ I hereby certify t f I have prepared this ap cathe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re lations of the San Joaquin Local Health District. . Si ned J� C (�r Contractor) ( 9 -- BY: -- ---• �' -----------------------------------------(Title)-------- 'x -- (Plot plan, showing size of lot, I ion of system in.relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------- -----------------------------•-------•-------- DATE-------------- r - REVIEWED BY DATE r� -------------------- BUILDING PERMIT ISSUED------------------ ------ --- ------ --------- ----------------------------------------------- DATE------- ------------------ Alterations and/or recommendations:-- ---- ---- -------------------------------------------------------------------------------------------------------------------- ------------ ------ --- ------------ x -- - - - - - �� -- ------- ----------------------------------------------------------- - --------------------" -__-----`-'-.---.__.-. -_--------- ----------- __•- -_-_'-_.•____------------------_-------.•----______-.--------_----.._'--- s� FINAL INSPECTION BY: ------- -- --------- SAN ------- �./ ate-.. - 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 ES-9-2M . Revises 1.57 F.P.Co- A//G 6 3��