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,.s,� APPLICATION FOR SANITATION P � y1 �., PERMIT Permit No. --------------••--•-_--• (Complete in Duplicate) (, 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 549. JOB ADDRESS ANDCAT N •► - �'�/ �lV 'r._.- Owner's Name ----------- -------- Phone------•--•-------•-•-.--- Address---------- it--- ..------------- Contractor's Name ----- •-- ., ---__ / one r* ----------------------------- Installation will serve: Residence Apartment se ❑ Commerci I ❑ 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 =Y.0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay L2" Adobe 10 Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes [A No ❑ '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_-_-'A_%4r%4?Distance from foundation----/0_-- Material----- -------- ---- -_ No. of compartments------------- Size-- -b /�_-' _ iquid depth.-_� - --.-_--Capacity.- �y Disposal Field: Distance from nearest well...414%q_Distance from foundation-_/Q--__--_---.Distance to nearest lot line-.. _-_---- Number of lines---------------- --- Length of each line----_ ri g �------tr------Width of trench-----• -+�/ T e of filter material___- / Yps*,' --Depth of filter material length-.-� --------------------------- --- Seepage Pit: Distance to nearest well_- + w* ----Distance from foundation_ _-.__.,Distansp�to nearest to line_- Number of pits--------I------------Lining material-- --.Size: Diameter---33-----------Depth-_-. 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 buildin g ---------- i ❑ Distance to nearest lot line Remodeling and/or repairing (describe)-------- -------------- -----•---------------------------------------------•--•------------•-----•-------------------- XVi ----------------------•--.•-------------------.---•----------------=---------------------•-----------------------------------------------•-------------------•-----------------------•-------•------------------------------- -------------------------------------------------=--------------------------------------------------------------------------------------------------------------------------------•--------------------- --------- 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 a regulations of the S Joaquin Local Health District. (Signed)-- ----- -------- --- --------- - ------ ---- -- ---- ---- ---- ------ -- ------ ----- ------- ----- --! --(Owner and/or Contractor) By=--•-----------•-- ------- {Title)------� ---- ---- -------------------- - (Plot 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--,e----------•-------•------------------------------------ REVIEWED BY------------------------------------- ------ --------- :: DATE BUILDING PERMIT ISSUED__---------__ --- 'raDATE-__--_-_._ _ Alterations and/or recommendations:-----_-.----- _ - -- --`-- - --- -------- - ----------L-----y, . — - ° - --- -- ._ ------------------ ----------------------------- ---------- ,. ------------------- ------------------------------------------------- - ------------------------------------- FINAL INSPECTION BY:.---- ------------------------------- Date---4--r--'L ` r ------------------------------------------------------------ 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 1-57 F.P.CO.