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APPLICATION FOR SANITATION PERMIT Permit No. 1 b (Complete in Duplicate) /� G Date Issued Application is hereby made t the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wifh County Ordinance N . 549. JOB ADDRESS AND LOCATION_ Owner's Name------------r- ` �- a -- ----- �! ----------- - ---- -------------------------- - -- - Phone------------------------- Address------------ Contractor's Name----------- --- <4 -------------------------------------------------------- ----- ------ Phone---------------------------------- Installation will serve: Residence R��Apartment House [] Commercial ❑ Trailer CoOrt ❑ Motel ❑ Other ❑ Number of living units: __/--_ Number of bedrooms __ Number of baths!- Lat size __. bx_ �--�•pr_-- _------.--__ f Water Supply: Public system qr-6Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?'Vardpan ❑ Previous Application Made: Yes ❑ No 23'-New Construction: Yes gj-'no ❑ FHA/VA: Yes-�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)" Septic lar Distance from nearest well------� -----Distanceljrom .__ foundation---/Q---------MatpGal_-_ erg No. of compartments------2 -Size__ -Liquid depth __------_CLCap-acity__-_--'�-_-__�- - i - . Disposal F' Id: Distance from nearest well_____ ------Disfancejrom foundation_4�--------Distance to nearest It line__-07--- Number of lines------ �p� Length of each -----------Width of trench..-- !-- --------------- T e or filter material -- G- yp r / lJ Depth of filter material---IP- /-----Total length ---_ ---------__---_--- Seepage Nf- Distance to nearest ell-------- ---Distance�fr m f ndation---p_-_P..-.__.DistancP to nearest lot line--_ Number of pits------ --------Lining material-- 'T��--.-Size: Diameter---k ----.---Depth---- ---'Y . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----.-Z2-1 a-v_.Q Z ❑ Size: Diameter------------------------- ---------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--_______--__-_-------___-------------.-- ❑ Distance to nearest lot hne---------------------------- Remodeling and/or repairing (describe):-------- ( r f --------------•------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------•----------------------------------------------•------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. (Signed)..--.. ` -------- ----------------------(O�-er Contractor) ---- By:------------- ------------------------------- ---- -5in — --------------------------------------(Title)--- '/ (Plot plan, showing size of lot, locati f system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- +FR -- '---------------------------- -- ----------------- ---------------------- DATE---------- -- REVIEWEDBY----------------------------------------------------------------------------------- ------------------- ------ DATE-------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- --------- DATE Alterations and/or recommendations:-----------------------------------------------___--------------------------------------------------------------------------------------------------------- --- w z - -----------z ----"--` -----Z-}--- ---E----- ------ --- -- - + ----------------------------------------------------------------------------------------- ------------------- -•--------------------- ------------------------- ------- ---------------------------------------------------- t FINAL INSPECTION BY:. Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT -"Tk '± 130 South American Street 300 West OafcfStreet 132 Sycamore Weet- {`814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revisea 1.57 F.P.CO.