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r 3S - APPLICATION FOR SANITATION PERMIT Permit No. _.-_`�..........------- (Complete ..... (Complete in Duplicate) / 7 .. _ 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. t - ------•- - -- JOB ADDRESS AND? OCATI _ .:_�--�__�? Owner's Name-_ �_-_ - r � --- ------ ----------•-------h------ :--•• ;--------. - •---------•,� -- •-- -- ---- - -^ ----------------- It�. . ... _ . -------- - ------------------ ---- one ------ ---- Address ` - ----------------------- -------------------------•-•-----•-- Contractor's Name--- ----------------------- -. - -----------------------• ------------------ Pone-------•--------------- Installation ------•-- -Installation will serve: i Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ -.Mof ❑ Otherl❑ Number of living units:_-' Number of bedrooms __& Number of baths� J---- Lot size __ _€• ,_ Water Supply: Public system"[ Conimun'ity system ❑' Private ❑� Depth to Water Table ________--ft. ,� .1 i Character of soil to a-depth of 3 feet: San E] Gravel❑ Sandy Loam [jClay Loam ❑ Clay E] Adobe Hardpan ❑ { Previous Application Made: Yes F] No R New Construction: Yes RKNo ❑ FHA!/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS:. : G (No septic tank' er'cesspool permitted if public sewer is available within 200 feet;) Septic ,ank: Distance from nearest well______' _lististonp f o fo �lation_J_ '_ ! f' .----------°Mat/ ial / --------- No.,of co- mpartriien#s___ _ t--- -'_-- Size------------ ---•---•---Liquids depIh--'---t7""----------------Capacity---- b --- !/_D-----, t r p Distance to nearest I Ii Number of lines-________-_ � 1. ----_Length of each line_---_ b g rT------•--•---- Dis os 'Field: -Distance from nearest well.- . - _Distance from foundatioq_ � r Width of.trench._____: _ - Type of filter matelia_ _.__ Dopth of filter 'mat --- _ ----__._-Total length-�__--..._LZ___0--------------•- Seepage Pit: Distance to nearest.well_w____-________ _Distance from foundation-----------------=__.Distance to nearest lof line______________._ ❑ Number of pitsi-_J-------`------Lining material------ ----------------Size: Diameter----------------------Depth--------------------- Cesspool: -----------------Cesspool: Distance4fro`m nearest well---___r__---__-Distance from foundation---------------------Lining material .___--.__.____._______.__ ❑ Siie: Diameter-- ' = r{ :_Depth----=- _ _ Liquid Capacity --------------- gals. f'�l - Privy: Distance from nearest v✓ell______________________________-__;_________----Distance from nearesfi buildin �. g-------------.------:---------------------- D ❑ Distance to nearest lot fine = `- ------`----=----- — , ..c...r,,.,_,.. .1. . . N --- --- ------ ----- ---- Remodeling anal/or repairing (describe): pi --------.. --------------------------------- _ } ! `-- - :.. C k — ------------- -----------------------------------------------------=. ----------•------------•--- ---------------------------------------------------- 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 iand regul tions of the San Joa uin Loca ealth District. , (Signed) --- =/--/--- --------------- --- --------- ----- -- (Owner and/or Contractor) By.— -' - - (Title) (Plot plan, showing size of lot, location of system in.relation to wells built ngs,.etc., can be placed on revere side). ' FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED B DATEt—:' REVIEWED BY - i DATE tA BUILDING PERMIT ISSUED__--- ------------ - ----------- = ----------- DATE---- Alterations and/or•recommendations: _____.-------------------- ------------------------------------------ y ------ -••------------- ------------------------------------------------------------------ ---------- ' - ------------------------------------ ----------------------------- ---- -- " ?FINAL INSPECTION BY--- _Z - = -= Date----- • = i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 FY.CO.