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e� f i U0 Permit Na.APPLICATION FOR SANITATION PERMIT _ ,. (Complete in Duplicate) Date Issued [ P P .____��tPo This Permit Expires I Year from Date Issued Application is hereby made to.'the San Joaquin Local Health District for a perrnit,to.Construct and install the work herein described. once with County Ordinance No. 549. This application is made in compli # o 3 JOB ADDRESS AND LOCATI� N --=----•------X- � �� --- i �� ; . • -s.f _ ? l�S ------------------------=---------------------------- Phone----------------------------------- Owner s Name----------.� •- ----------------------------------------.-------------------------------------- Address----- .-------Address----- ----- ----- / ------------•--------------------- r :1 ----------------- -- _._ Phone Contractor's Name------------ .------... Installation will serve: Residence Apartment House ElCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ X J __-. Number of bedrooms _-1--- Number of baths --/-_ Lot size ___6-b---X-------------- Number of living units: _� b - 'I Water Supply: Public system Community system [IPrivate E] Depth to Water Table --4Vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No [�f- New Construction: Yes ❑ No_K' 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 well_-V11'-9_Distance from foundation---�� -____._.Material___ .C' ✓---••----- No. of compartments...___, .............Size__ ---ti00 - if------...Liquid depth�rd-'rj-------------Capacity---- ``qq - � Disposal Field: Mstance' from nearest well.-Aht�l Distance from foundation _____._.__.D�stance to nearest lot lin`f5----------- f 1 Number of lines------- ------------------------- 9 Yx Len th of each line�:7_�"------------Width of trench_____ ___ ___ __________________ Type of filter materia __- -- ---Depth of filter material------ /Kf ---.-Total length___r �_--f_ ----- l- --- i -_Distance from foundation---- Dist��a to nearest lot liney�_____---.-- Seepage Pit: Distance to nearest well 0�� ------ ` ,� > Number of pits-------1-------------Lining material--- �--.--Size: Diameter--�r�-----------.Depth-----t2-S------------------- V 5 Cesspool: Distance from nearest well________________Distance from foundation_----- _-_-_._---- Lining mate'rial:...---_.._._-_.--.-_____.______--.-. ❑ Size: Diameter-------------------------------------Depth------------------------------------------------- Liquid Capacity gals. Privy: Distance from nearest well----------------------'--------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------- - ------------------------------------ ------------•---------------------------------------- ---------------- Remodeling and/or repairing (descr&e):------------------------------------------------------------------------------------------------ -------------------------------------------------------- -------------------------------------------------- --------�-------------------------------------------------- ----- - - -- -- ------ ---------- I hereby certify that I have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul and regul ons the San Joaquin Local Health District. �wells, ___._.Owner and or ontraC ctar) (Signed)----By:----------------------------------------------------- ----- --(Pio+plan, showing size of lot, location of system in rely ion +o buildings, etc., an be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. - ~ --.- -------------------------------------- DATE -------------- DATE_. U ---------------------------- - REVIEWED BY------------------------------------ ----- -------- ------------------------------------------ - DAT E------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- Alterations,and/or reco Ti" pndations:__ - -------------------------------------------------------------------- If— _ - - � -------- ---------------------------------- -- - -- ----- -- ---- - - �- , �� -------- - --------- ..__ FINAL INSPECTION BY: --�--------�---��'"Y-'= ----- ---- - ---_ Date -"� � � l, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" r-et • � Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Rsvised 8.'59 F.P.Co.