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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ."""".l�-"� Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made-in compliance with County Ordinance No. 549. �� ' 7 i,12JL� JOB ADDRESS AND LOCATION.---__ (� __ __"" ""A�i -----1 .�" _Lc.� fl9 Owner's Name___ _1- _ 4.- -61.►, �,.--• ----- ------- -------- ----------------------- Phone--� ,3P Address------------- _ern _ - , Contractor's Name : __�-= -1 Pitone Installation will server Residence'[] Apartment House ❑ Commercial ❑ Trailer Court ❑ 9*-- !Motel ElOther Number of living units: _'__1" Number of bedrooms _ ... Number of baths -6-_ Lot size _--."!._ + ,.�►" _-------------------•------- Water Supply: -Public system ❑ Community system ❑ Private [:❑ Depth to Water Table 4%� ff., Character of soil to a depth'of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e"Hardpan ❑ Previous Application Made: Yes 0 No 0 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or'cesspool permitted if public sewer-is available within 200 feet.) S Distance from nearest well-----------------Distance from foundation--------------------Material -" __-__. No. of compartments - Size-------------------------------Liquid dep h--------------- Capacity Disposal Field: Distance from nearest well--I�--____.Distance from foundation--"� _ ee ---- � Distance to nearest lot line"�d"""f'r-"" ,Number of lines_--" -__-""_ --- "Length of each line--- `�-- Width of trench_- �---_ '� • ° Type of filter material `Depth of filter material___//_-"---------Total length-- -------------kr_,-------------- Seepa 'Pit: Distance'to nearest well _10-4--!------4Distance from fou ndation_-/P --------Distance to nearest loft line-.1 I Number of pits----I-----" ---Lining material--- ' �* - - -----5iie: Diameter----�-,�--------- DeptDist nce from' Size: Diameter ineaTest well:-- ___-._-`--_ Dbepth Ce from foundation-"""--- - ---------L Lining Cat act --------------- ---- ---- Liquid p ! Y------•-----------------•---gals. Privy: Distance from nearest well------------------------- ---------------------Distance from nearest building Distance to ne'rest lot lire---------------------- Remodeling and/or repairing {describe :-__ 5 _ ____" ----------•----------•------------------------------------I------------ --------- -------------------------------------------- --•---------------------- ------------------------------------------------------ = -------------•----•-------------- ;i- --- -------------------------------- --------------------•------------------- ---------------------•-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in-accord-a-nce with-San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin L5V)_1 ealth District. F (Signe d} .. �'�Q1 - - - C. i r"` Contractor) BY:-------•------------- -•-----------------•-••--------------------- - ✓ . (Title) -=------ (Plot plan, showing size of lot, location of system in relation wells, buildings tc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , •------------------------- ------------------------ ----------------------------------------- DATE_=;r.-".-.. REVIEWED BY ----- ----- DATE-_ BUILDING PERMIT ISSUED DATE----- Alterations and/or recommendations-------------------------------------------------------- ------------------------------------------------------------------------------------ -------------------------------- •----------------------- -----------------------------------------•------------------------ ----------------------------------------------------- ----- ------------------------------------ -----------2--- ------ v-- - -------K FINAL INSPECTION--BY Date = 7 �` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California Lodi, California Manteca, California Tracy, California E5-9-2M , Revises 1-57 F.P.CO.