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� �� APPLICATION FOR SANITATION PERMIT Permit No. __ .-��'-- ---- 1 � 1 (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 wit -C,.oun`y Or&nanccee No. 549. f fid ` -'-`--------�----- 3'-- 6F JOB ADDRESS AND LOCATION ' r ,,C --'e' -----------------------------------= Phone.�a--S' Q �1 ------6-r Owners Name____ ___ ___________ .� --•------------------------ -------------------- ---------- Phone------- ------------------------ Contractor's Name-----------------•----•------------------------------------- --- - Installation will serve: Residence[< Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ U---- -- --------------- Number of living units: __/____ Number of bedrooms -j... Number of baths - Lot size ___ -- - . ble PrivateDepth Water Supply: Public system p Community system ❑ ❑ to Water Ta Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam { Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ' Previous Application Made: Yes ❑ No K New Construction: Yes '" No El ' FHA/VA: Yes E] No Elf TYPE OF INSTALLATION AND SPECIFICATIONS: ` x i (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) """'~"*' _--Distance from foundation_-.;� -----------M serial_- -- ----- --------- ------ Septic Tank: Distance from nearest we L________-_- . No. of compartments---- � Size - X-,- -•Liquid depth-------------------- CapacitY- 0 ----- f __._.Distance to nearest lot line`-____-.+►!------- Disposal _-._Disposal Field: Distance from_nearest well "-Distance from foundation__ 2-6Number of lines--------- ___ Len gth of each line-------- Width of trench_____ ___S------------------- Type of filter material-_ -__- Depth of filter material---- -- -------- Total length--------.�,�-------------------• w,- Seepage Pit: Distance to nearest well-------------_--------Distance from foundation----------------..Distance to nearest lot line..___________-.__ Number of pits Lining material-----------------------Size: Diameter-----------------------.Depth---------- ---------------------- f , ❑ f"f�1 Cesspool: Distance from nearest well-----------------Distance from foundation-__---____________Lining material_____ ._.___-.---------------als. W ❑ Size: Diameter--------------------- ---- Depth----------------------------------------------------Liquid Capacity--------------- 9 r ; i - * • r - - ---------- ---------Distance from nearest bu Privy: Distance from nearest well-------------- ------------- ilding------------------------------------------ ------------------------ - - ------------------------------------------------------------ ❑ Distance-to nearest lot kine--- ' Remodeling and or re airin describe -----------------------------------------------------------••------------------------•----------•------ -----------------------------------------•--- ---------- ----•-----------.--------------------`---------------------------------------- I hereby certify that 1--have--p repared Phis applicat�en and that the work will be done in accordance with San Joaquin Co-,nty,•, . ordinances, State laws, rules and regulations oft n Joaquin Local Health District. Si ned /�/�f . . . - --------------- ---------------------------------------------------------(Owner and/or Contractor) ( .g ).' -//# ---- - Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY i _ APPLICATION ACCEPTED BY----------- DATE_-_________ :- --------- REVIEWED BY. r ----------------- DATE--------- -�---- ✓ ----•-•------------ -- ------------ =------------- - ' - -- ----------- ---------• DATE-------------`---------------------- ----------------------- BUILDING --------- --------- -- BUILDING PERMIT ISSUED________________________ - -------- Alterations and/or recommendations:._-.__�--.-- - -----`-.^------ - - - --- --- -----•-'---•'"----- ----------------------------------•• --------------------------- - -----------------------------------------I--------------------------------- --------------------------11---------- ----------------------- ------- ----------------- ------------I-------......I------------------------------------------------------------------- --------- ---------------------------------------- -------------------------------------------------------- �- __--°--. Date.,, ' L1-----✓--------------------------------------------- FINAL INSPECTION BY:-- SAN rl UIN LOCAL HEALTH DISTRICT 300 Wes+Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. E5--9-2M : Revised 1.57 F.P.00.