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jAf APPLICATION FOR SANITATION PERMIT Permit No. ._. •.0_._7.. t'y3� (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 inance No. 549. JOB ADDRESS AND LOCATION--------- 16 - - -----------------------------------------------------------------------------=-------------- Owner's Name. l ' -- Phone------------------------- Address-------- ------ ------------------------------------------------•--------------•--------. ----------•-•••-----_.. Contractor's Nameia � az7r ..t-=----�4"/� - Phone Q� Installation will serve: Residence ❑ Apartment House commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J0 Number of bedrooms __l Number of baths -14- Lot size __ ,l! _Qr(j?►4f.................................... OF Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table .7-3 ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq--nardpan❑ Previous Application Made: Yes ❑ No 2- New Construction: Yes ❑ No e'' FHA/VA: Yes ❑ No R!�"- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi nk: Distance from nearest well_________________Distance from foundation-----.--------------Material---------------------.-------------.___.......... No. of compartments--------------------------Size--------------------------•-:---Liquid depth--------------------------Capacity--_------------------ lipw Disposal Field: Distance from neares well -_.-Distance from foundation_____..--i________-Distance to nearest lot line................ Vol' Number of lines------�_________________ _Length of each line-_-_-__ __--`/__.....Width of trench____� ......................... _/�`_... Type of filter material/ ._/� Depth of filter material__,l�__.__�..._.Total length-------- _�-------------�--- Seepage Pit: Distance to nearest well------- '.---------Distance/frpm fo ation...149.-_-._...Distance to nearest lot line_ - Number of pits.-..- -------------Lining material/. A ize: Diameter.-"'t f/-----._Depth____�..✓�__- _r_--------- \"L Cesspool: Distance from nearest well__-___-___-__-_Distance from foundation___________________Lining material-------------------------------------- � ❑ Size: Diameter------------------------- ------Depth----------------- -----------Liquid Capacity-------------------------..-gals. Privy: Distance from nearest well---------------_----------------.----------------Distance from nearest building--------._.-._-.----______--_-_.-_-__----. -__y ❑ Distance to nearest lot line----------------------------- ------------•--------------------------•-------------------------- •----------------- Remodeling and/or repairing (describe)------------------L 'C +'----- 1. � -------•------------------------------------------------------------=-----------•-----------------------------•---------------------------------------•-------------------------------------•----------------------•---------- ---------------------------- ---------------------------------------------------------------------------------------------•-----------------------------------•----------------------------•-----------------•------ 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 regul tions of a San Joaquin ocal Health District. • (Signed)--------------•.... . -- -- ---- ------- - -- --:-------------- ------ ------------------ -- 19 -Contractor) By:............................--- - ------- - ---- - -- --------------------------------------------------------(Tale)-�i� � -- (Plot plan, showing size o t, location of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- -- ----------- ---- ------ --------------- DATE_-.••-- - REVIEWED BY J__< DATE - BUILDING PERMIT ISSUED---------------- - ------------------------------------------------------------------------------ DATE-----I Alterations and/or recommendations:_- -----------------------------------------------------------------------------------------------------------•------------ •----•... -- - -----------------•--- ----------•--•-----••------- ,s ,S fc e C' ------------ --- ................---_.._...---------•-•----------------•-----•---•-------------------------------_.._.•--------------------------------------------------------_ -.- -- -•--- --------------------------------------------------------------'-----.----•---------. •-----.---_-•---------------•----------- ( l FINAL INSPECTION B` ✓-=1- ~' Datet-4--Z,-'S 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.