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�Permit to t2- APPLICATION FOR SANITATION PERMIT (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 No. 549, JOB ADDRESS ANDOATIO # ---------------- ------------------•-------------------•----------------_----- r - ----- Phone------ •------------•----- Owners Name------- --- Address_----------- --------- - ----- ---- __%---------------------------------------------- lie f �r ?hone.Contractor's Name-- - --- --- Installation Installation will serve: Residen Apartrr�nt House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----C_ Number of bedrooms __ Number of baths __t___ Lot size -_-_ _____________________________ Water Supply: Public system R[" Community system ❑ Private ❑ Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: ,Sr nd ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe® Hardpan [] . Previous Application Made:. Yes E]- No,DL 'New Construction: Yes E] No ❑ FHA/VA: Yes ElNo El 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 Distance from foundation____ �___.____.Mateial____ _dl ' ----- ---- No. of compartments___------�._ __Size--- _____ _ "------_Liquid depth____ ________________Capacity--- ._ Disposal Field: ..Distance from nearest well....'. ;Distance from foundation__�iq-______.._Distance to nearest lot linea'__.___.... [ , Number of lines-_--__.____J.-.-____-�-----_Len th of each line____ g Width of trench T ` e of filter material----I ___. *-` De th of filter material____j_ _ '_________Total length___.____________________r___ I Yp - �-- ==- p � - �_ ` - Seepage Pit: Distance to nearest well_ ___-_Distance fromf ndation_-_1 __...___.Distance to nearest lot line_ ____________ Num6er'of its`_____ Linin material___ ._Size: Diameter------ - -------Depth[ . w ., r p l d g p :---------- Cesspool: Distance from-nearest well-----------------Distance from foundation---------------_-----Lining material-------------------------------- _____. El Size: Diameter l-------------------- ---------------Depth_-------------------- - -------- ---- -----Liquid Capacity----------------------------gals. \N Privy: Distance from nearest well------_-----------------------------------_------Distance from nearest building_:____________________________-----.___.. Distance to nearest lot line_ •_________________--r='-- - - Remodeling and/or repairing (des ' ------------------------------------------------------ -T E-•-------------- •------------------------------ --------------c-•-----------•-•- -- ---- --_----- E ----------------------------------------------- ---------------------- - -------------------------------------I---------------------------- -------------------------------------------------------------------- - \ I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws.Ad rules and regulations of the San Joaq 'n Local Health District. ' -- ----- ---------------------------------Owner and/or Contractor) (Signed)------------------ ----=---- ----- BY� -- --------------------------------(Title)- -- • -------------------- ------------ ----------- , (Plot plan, showing size of lot, lata ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.----- ---------------- 9 DATE--- ------------------------•-.-------------------- - REVIEWED BY = " �-x�;, --------------------------------------r-------- DATE. •--------•--- BUILDINGPERMIT ISSUED----------=1------ -'- -- 721----------------------------------------------------------------- DATE----- ------------•-4----------- ------------------..._. , Alterations and/or recommendations:_.._-- --------------------------------------------------------- =--- �_ ---� --- -------------- -- I ` ----- - --- -------- r.-�e _------------ � - )---------�----------- - ------------5"u, -' •--- •--- --- ---- --------------------- -•-------------------------------- ee77 --------- =---------=='•--=- f -Date__--------�---1-- ---4 -------------- I FINAL INSPECTION BY..... - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street F 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.