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APPLICATION FOR SANITATION PERMIT Permit No. _. _-�__Z— (Complete in Duplicate) Date Issued ---_____l_7_A-7 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 O inance No. 549. E JOB ADDRESS AND LOCATION..--- - 1_ ------ Owner's Name--------- ----------- - Phone---' hone-- j. � Address---------- ------•--- - -- -----�--•------ Contractor's Name---- ------- til- ---•---------------------------- -------------r-------------------------------------------------- Phone------------------------ --------- Installation will serve: Residence [s Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _'_1---- Number of bedrooms ---(____ Number of baths __�---- Lot size -----1 S� r K -(�t Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table 4-a_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam V Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No R/ New Construction: Yes &�r/No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted'if publiceewer is available within 200 feet.) r - ��4G dt iA�$ Septic Tank: Distance from nearest well__ ____Distance afro foundation____t_ _____.__.Mat riiaL_ ________ ____ ___________ Septic No. of compartments -- 3X j---------- depth------` '"-------------Capacity--- p C�--------- Size-•-� --- Dispo I Field: Distance from nearest well-_-> ------Distance from foundation__�__/0_________Distance to nearest loin line--- ---------- [ Number of lines-___-_-_I------,r �. -.__-Length of each line___�Q_____ .______._.Width of trench______ e---------- ------------ Type of filter material------ _ Depth of filter material-_-__��__-______-Total length------- Q-------------______--___- Seepage Pit: Distance to nearest well---------------------Distance from foundation___-____--_-•_.._-_.Distance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Dept n--------------------------------- Cesspool: Distance from nearest well-----------------Distanrle from foundation--------------------Lining material--------_______----_------.---____-- ❑ Size: Diameter------ -------------- ------------ ---Depth-------------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_--------,___---_----__-_--_ ❑ Distance to nearest lot line---------------------------- --- -------------------------- Remodelingrid/or repairing (describe)------- ---- -------------1 ---------�--------------------------------------•------•------------------------•------------ ------------------ -------------• - - - t--------------------- ------------------ ---------- ------------- ------- --- ------ 3 ------- - ----- - - - ---- -- - --- -: -- -. - I hereby certif I have prepared this applica on and that the work will be don n accordance with an Joaquin County ordinances, State , s, and rules and ulations of'the San Joaquin Local Health District. ned -' ' (Si 9 }V - - ---- - ---------------------(Owner and/or Contractor) :------------------------------------------------•------------------- ------------------- ------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ --- ------------------------- DATE------- REVIEWEDBY--------------------------------------------------- -------- --- ---- -- ---- ----------------------------------------- DATE------- BUILDING PERMIT ISSUED------------------------------------------- -------------------------------------- DATE Alterations and/or recommendations:---------------------- ------------- - - ------ ----------------•- G------ •- ---------- - -- ------------ I - ' `-f '(0-�' ��" 5 :._0A-- �_` .-a In ,_+ J��±;._tLa-----------Q------ --� ------------------------------------- ------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY---------------------------------------------------------------- Date --------------== ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revises 1-57 FRCO.