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FOR OFFICE/USE — -. ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. �'r� /7—' -------- ----------------------------------------------- (Complete in Duplicate) ------------------7----------- This Permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f This application is made in compliance with County Ordinance No. 549 J08 ADDRESS ANDCATION._.,f� Owner's Name..__ - ------•- . ..--_ ` -------- ------ Phone---------------- Address------- % Q '... Contractor's Name____________ I - -�------------- • ------------------------------------------ Phone------.........--- ® Installation will serve: Residence 'Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - -_ Number of bedrooms?_ Number of baths--- Lot size Ze"7X1W'- Water Supply: Public system ❑ Community system Private ❑ . Depth ro Water Table /6;,ll i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe Hardpan ❑ NPrevi us Application Made: (If yes,date___________________) No 9?"-New Construction: Yes �IVo El2?--NoE]FHA/VA: Yes 2?--No i OF INSTALLATION AND SPECIFICATIONS: (No septic tankor cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel �''----Distant from foundation--- No. oundati n__. _ a _.. .Material_ ........ ............. L+3' No. of compartments -----------Siz 'tee � ii-;e squid depth Capacity l..rf.�Q. Disposal Field: Distance from nearest well---- '�----Distance from foundation-....� Distance +o nearest lot line. ----• x-�---- Number of lines...... _______ .Length of each line1�QA! ,�--1/�/idth of trench.- ,eg _ Type of filter materialii Depth of filter material_ - length.. ---•- 4 , ''._______._Total len th.._ __ Seepage Pit: Distance to nearest well--------77 -----Distance fr fau tion.... _ ` ' Number of its____ �f �•st n,�ce to nearest lot p .�___..______Lining material-_,#___ Size: Diameter-,27 . . Deptho Cesspool: Distance from nearest well____________ _ Distance from foundation--------------------Lining material-------------------------------------❑ Size: Dia.meter ---------------------•-Depth--•-------------------------------- - ---------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well----------_-------------------------------.------Distance from nearest building ❑ Distance to nearest lot line___ ' _ ---------------------------------------------- Remodeling and/or repairing (describe)=-----------`,�' `� � _ , -------------•--••--------------- ------------------------------------ -------------------------------------- certifyt ----------------------------------------------------------------•---------------•------ ---••--------------------••--------------- hat I have prepared this application and that the work will be done in accordance with San Joaquin County h I hereby certi ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) i - ------ ----- - - ----------- Contractor) BY= .............................................................. Title__ ( } 1 (Plot plan, showing size of lot, location of system in ation t0 wells, buildings, etc., can be placed on reverse side). FORDEPA TMENT 'SE ONLY APPLICATION ACCEPTED � �- -- -----_ p --.,, DATE REVIEWED BY------•-••----------•-------------•------- --- - -- ----------------------------------- ----------------- ---•--------------=_------ , --------- '- DATE--- ---------------------------- UILDING PERMIT ISSUED---------- ---------------- r --•--- .�* Alterations and/or recommend'ations:____ z_1 — ------------------�'----.-- --_-_ •- -• •. -•---•-••----••-----------------•--------- ------------••----•------••------------------------------------------ ----------- -------- - ' flNAL INSPECTION . .. -- ------ ----- --- ---- Date__ - SAN JOAQ N LOCAL ALTH DISTRICT 130 South American Strut 300 West Oak street 124 Sycamore Street Stockton,California 205 West 9th Street Lodi,California Manteca,California ti Tracy,California VES 9 REV15E❑ 8.59 EM 5-52 A7LA5