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.APPLICATION FOR SANITATION PERMIT Permit No. �y � t (Complete in Duplicate) �� a! i e Date Issued r 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.--=- .Wil_-V--�------_----- 1 - --- --------- ----,-- Owner's Name----------- L Z =--------------- ----- ---------------------- ------- on - ---- -Q.. ._: ------------•------ Address .... Qom_/-1�,L' -----------• k � � Contractor's Name = — Phone.................... . s Installation will serve: 3 Residence 1V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [-I Other ❑ Number of living units: -1_:-- tuber of bedrooms -__ __- Number of baths I---- Lot size -----�-Q--_-�---�'-�--------------------------- r Water Supply: Public system Community system El. Private El 'Depth to Water Table 4U"ft.. Character of soil to a depth of 3 feet: { Sand D Gravel ❑ Sandy Loam Clay Loam [I Clay El Hardpan Hardpan ❑ Previous Application Made: Yes ❑ No T/ New Construction: Yes No ❑ FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Septic O-S�ADistance from.nearest well----------------'Distance from foundation---------------------Material ._-__-_---:-__.------_:.__.----_-_----- --___. No..of compartments------------ -------------Size-------------------------------Liquid depth--------------------------_Capacity----------------------- ' �r 1/6-----__.Distance to nearest lot line--- -• ----- Dispas Field: Distance from nearest/weILJ�h��_Distance from foundation----Number of lines::--'___,c- Length of each line___----- ----`---`Width of trench.-___ �_ '---------------- Type of filter material--: �_l ----Depth of filter material___-I-r-�___---Total length-------__ �------------ -- Seepage Pit: Dian stce to nearest well---------------T_--Distance from foundation---_..._--_-..--__. .Distance to nearest o ne--- -r ❑ Number of pi+s-'----------------.---Lining material-----------------------Size: Diameter-----------------------Depth---------- ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-----------------------__-------_ s --=-----.Depth--------------------------------------------------•-Liquid Capacity---------------------------gals. C ❑ _ Priv Distance from roar est crest well----------------------------------------------------Distance from nearest building--------------------------------- Distance ---�---- Y= � . ❑ Distance to nearest lot line---------------- ------ --------------------------------------- ------------------ ---------- Le); --------- Remodeling and/or repairing (desc ibe):_-- ��t ! , --- ~�`�' -------- Remodeling -------------------------------- -.l -------•---------------------------------------------=--------=---------------------------------------------------- ----------------------------------------------------=--•------------•------------------•--------------------------------- ----- I hereby certify that:l 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. (Owner and/or Contractor) . . (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, I DATE-------------- --------- APPLICATION ACCEPTED BY------ -- ------- --- `-------------------------- ------- --- ------------- REVIEWED BY--------- - ------------- -- -- - DATE----- BUILDING PERMIT ISSUED--------------- ---- -- ------------------------------------------- DATE------V-- - - Alterations and/or recommendations: __ -------------------- ---------------- ---- ------------------ -- .I_F _ = FINAL INSPECTION 13Y%___6_ --- ---- ----, =� �i 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., Revised )-57 FYCO.