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-7— V�,� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a perm�-fq consfruokan tall the work Inein d2scrib j�,d. This application is made in compliance with County Ordinance No. 549. /7(1 773' JOB ADDRESS AND LOCATION- ------------------------ Owner's Name---------- - ------------ -- Phone-----•----•-------------- Address---- -----------�L_-:Lln----- ------------------------------------------------ Contractor's Name---------irft_t-- ------ --------------------------------------------------------- ------------------------------------------- Phone----------------------------------- Installation will serve: Residence;K Apartment House F] Commercial [j Trailer Court E] Motel 0 Other 0 Number of living units: A---- Number of bedrooms _Number of baths j--_- Lot size ------- --------------- Water Supply: Public system E] Community system C] PrivateN,� Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy L 0, E] Clay Loam 0 Clay E] Adobe Hardpan E] Previous Application Made: Yes E] No 9N New Construction: Yes K,No E] FHA/VA: Yes E 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 weil__�-------Distance from foundaflon--.1-tZ------ k Mat rial---0____ Q7 --------- _r ------capa�'i� �ty _ No. of compartments__'__)i--—----------------- ------Liquid depth----_--- ---------- 1K -----Distance to nearest lot 'n$-----S� ----- Disposal Field: Distance from nearest well- Distance from foundafion-_-1-C�--- Number of lines-_-_--- ----- t�ent�noiof each line----- )6�---a---------Width of trench.._ -4--------------------- - Type of filter material------- - of f filter material-:--.I---8----.-----Total- length-------V__`�__b--------------------- __we11ll Seepage Pit: Distance to nearest well__________-.________Distance from foundation-------------------.Distance to nearest lot line---.------_-----_ �\' ine----------------- �', F1 . '. Number of pits----------------------Lining material-----------------------Size: Diameter------------------.--_Depth--------------.--_.---------_.._. Cesspool: epth--------------------------------- Cesspool; Distance from nearest well-------------- Distance from foundation--------------------Lining material-------------------------Z---------- F-1 Size: Diameter------------------------- ------------Depth-------------------------- ------.------------------Liquid Capacity--------------- ---------- gals. Privy: Distance from nearest well--------------------------------------_-------.-Distance from nearest building.-----.-----------------.-------_-.-.----. ❑ uilding------------------------------------------ 0 Distance to nearest lot line-----r -------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------- ---------------------------------------------------------------------------------- --------------------------•-••------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- --------I------------11.1---------------- ----------------------- ----------------I---------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin Local Health District. (Signed)--------------------- ------ ---- ;;;;--------------------------------------------(Owner and/or Contractor) --------------------------(Title)---------------------------------------------------------- (Plot plan, showing size of lot, location of system in �r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------- --- -------------------------------------------------------- DATE------ -------------- --------------------------------- REVIEWEDBY----------------------------------------------------------- -------------------------r--------------I----------------------- DATE ----- N-- -- -------------- ----_--------------- BUILDING PERMIT ISSUED----------------------------------------- --------- ------------------------------------- ------- DATE-------- -- -,< -------------------------------------- Alterationsand/or recommendations:-_---_------------------- - -- --------------------------------------------------------------------------- - -------- ---------------------------- ------------ -- -------------------•------------ ---r-------- ---------- ------- ----- --------- ....... ------------------- ----------- - ------ -------------------- ---------- ........ -----il�- ---:-�-:�q-, %_ --- ---------- - --------- ............ ----- --------- - ------- ------ -------- ------ --------- ------- 2-1,'N�----------- FINAL INSPECTION BY:------ - ------ --I------------------ Date---- ------4---------- 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 ES-9-2M Revised 1.57 F.P.CO.