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f Q : 49 APPLICATION FOR SANITATION' PERMIT Permit No. (Complete in Duplicate) / a Date issued Application i Arty 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. JOBADDRESS AND LO ATION.---_,J---- ------------5---- ---------------------------------------------------------------------------------------- Phone------------------------------------ Owner's Name-------- --- ------•---------------------------- Address-----------------..---- Contractor's Name----- Phone-------------------- - - ----------------- ------------------- ------------�- --------------- � Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other i Number of living units: _a-_ Number of bedrooms _Q_ Number of baths --a- Lot size ___:� d �1�_ ---�----- Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Table36_ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe [I Hardpan ❑ Previous Application Made: Yes No ❑ New Construction:` Yes E] No�FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) j, Septic ank: Distan e fr m n est. -Dig h e fror4� fou anon_ . 1�erial______________.--____---------- .-----------_--- No. 05'�, Liquid ep h Capacity ------------ Disposal /Field: Distance from nearest well`. Distance from foundation---- --------Distance to nearest lot [in e____---__---- i Number of lines------;2------- ------ --- Length of each line------6.0----------.--Width of trench---V_ --__�--------------- 7- ,----------- Type of filter material--- _ Depth of filter material_______ _ _____ __Total length---___�__ _ -_______________-.._ I� p �' f Seepage Pit: Distance to nearest well----------------g -__--Distance from foundation----------------_..Distance to nearest lot line----------------- I ❑ Number of-pits----------------------Linin material----- --------- Size: Diameter-------------- - Depth--------- ----------------------- Cesspool: Distance from nearest well-----------------Distanc'e,from foundation---.----------------Lining material------------------------------------- ` ❑ Size: Diameter------ ----------------- -------------Depth.---------------------------------------------------Liquid Capacity_.- ---------------------gals. `I ` Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_--_______,_-.--_------__----____-----. i l ❑ Distance to nearest lot line------------------------------------------------ ------------ ---------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------------- ---------------- --------------------------- ----•--------------------------------------- ------ --------------------------------•------------------------------------------------------------------ ------ -----•---------------------------------------------------------------------------------------------- 4 _ _ _ ------------------------------------------------------------------------------------------------------ I hereby certify that ! 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 t e San Joaquin Local Health District. ----------------------------Owner and/or Contractor By---------------- ----------- --------------------------- ------:-------------- -----------(Tit e --------------------------------------------- - ---------------- (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 APPLICATIONACCEPTED BY---- ------- ---- ------ ----------------------------------------------- DATE------------------------------------------------------------ Rl~VIEWED BY --- DATE----- . - 1 BUILDING PERMIT ISSUED t DATE------------------------------------------------------------- ' Alterations,and/or recommendations:.-__--._:_._--- .-_-_ i l -- ------------------------------------------------------------ ------------- - - ---------------------------- ------------------------------------ ---•-------------------------------------------- -- _ FINAL INSPECTION BY:-------- Date_...______--` ( -------------- SAN ----- -- ---- ---- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street i 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California 1 Manteca, California Tracy, California y =,9-2M , Revised 1-57 F.P.CO.