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APPLICATION FOR SANITATION PERMIT Permit No. __-7----3-3.1. �-� (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 with County Or inan No. 549. 'f� ADDRESS ANDPLOCATION-- -- Owner's Name ------------------ Phone. --- --•---------------- --------------- Address. � • -------------------- Phone ---------- Contractor's Name--------_-•-- -i's--�_ - --- --- -- --- Installation will serve: Residence ❑ Apartment House ❑ Commercial 2B- railer Court ❑ Motel ❑ Other ❑ Numbef of living units: __/--- Number of bedrooms _______ Number of baths --A. Lot size ---------- -------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ____„4' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No I?` New Construction: Yes ❑ No P- FHA/VA: Yes ❑ %No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from'nearest wel-----------------Distance from foundation---------------------Material------------------ ------------------------------ .. No. of compartments--------------------------Size-----•--------------------------Liquid depth---- --------------------Capacity------------------------ / -----------e------ ------ ❑ / r �T.-.___.Distance to nearest lot line___rs! !__..-- Disposal Field: D;stance from nearest well._.._-17 _Distance from foundatio __-______ Number of lines________ - ength of each line____�Y0_*---------------Width of french___ ------------------- Type of filter material_ __-__Depth of filter material----/_cP-_ -----Total length___ 40----------------------------- tYf...__..Distance to nearest loj linv__ Jf 01 -= Seepage it: Distance to nearest ---Distance from fou anon____ _.- /` Number of pits-- ---/------------Lining material/-_/��Size: Diameter--7-4 -----Depth__ , ---3 --------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- Size: Size: Diameter.--- ------------------------------Depth----- -----------------Liquid Capacity-------------------------•--9 El Privy: Distance, from nearest well-------------------------------------------------Distance from nearest building__---_____________---___________ ❑ - = - ------ Distance to nearest lot line----- = --------------------------- -------------------------- Remodeling and/or repairing (describe):- \n c/! `1] "�� --------------------------------------------------- --------------- ----------------------- --- --------------------------------------------------------------------------------------------•-•---------•------ - I hereby certify that I have prepared this application and that the work will be done in accordance wFth San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - [/-- Contractor) (Signed)---- ; {Plot Lplan, showir�g size of to+, locat' of system in relation to wells, buildings, etc., can be placed on revers +de). FOR DEPARTMENT,USE ONLY T DATE - --- APPLICATION ACCEPTED'13Y-- --•---- ------- -------------------------- --------------------------------------------- ---------- -------- REVIEWED BY----------------- 4 >" =;=:-_---:---- ------------------- DATE ti BUILDING PERMIT ISSUED--------- - --------- DATE `�1't---------------------------------------- ----- Alterations and/or recommendations---------=----- ------------------------------------------------ --------------------------------- �---- � ............P -----------------} ----------------------------------------------- -- - -• -- ... '�_- �: --------------------------------r_ ______________-------------_------------------------------------------- -------------------------------- - - - f FINAL INSPECTION BY.:7-'---------r--------------= Da te ------------------ r SAN JOAQUIN LOCACHEALTH DISTRICT 3D0 West Oak Street 132 Sycamore Street $14 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California Y. ES-9-2M Revised 1.57 F.P,CO.