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5 APPLICATION FOR SANITATION PERMIT Permit No. ____113_124_______. (Complete in Duplicate) y Date Issued Application is hereby made to the San Joaquin Lo I,Health)Di'trict for a permit to construct and install the work her in described. This application is made in compliancwith,Co fy O`rdinance 549. JOB ADDRESS AND LOCATION-- -=----- ----- '' " == -==��r )- Owner's Name ---------------------- Phone------------------- . Address_ - Contrac:tor's Name----------------------------------------- ----------------------------------------------- Phone Installation will serve: Residence•y Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,___ Number of bedrooms _ Number of baths _ ___ Lot size _ -Q_/ _z�____-_-_______________ Water Supply: Public system ❑ Community system ❑ Private, Depth to Water Tabl%,? ft. Character of soil to a depth of 3 feet: Sand ❑ Grove] ❑ Sandy Loam)K,,,Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoK New Construction: Yes ❑ No ("D' 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__ ____lJistan e from foundation------ _l -____.Material__.___._ ►h. No. of compartmenfis-___�_______________Size___ _x�_,�.5.___Liquid depth______-��__--------Capacity_.._��,.� Disposal Field: Distance from nearest well0------Distance from foundation__-10 ___.__Distance to nearest lot line____ -----•--- Number of lines____________ ___ ____ Length of each line--- ---�__--_ Width of trench______/,_j_ of filter material___ e p r-'� -u---- De th of filter material_____-1,P_.________Total length-------6-G--f-------------------- Type Seepage Pit: Distance to nearest well----------------------Distance from foundation:------------------Distance to nearest lot line______________.__ r Number of pits------------ ------Lining material-----------------------Size: Diameter-----------------------Depth-.-----------------_------------- Cesspool- Distance from nearest well-----------------Distance from foundation____________________Lining materia)------------------------------------- -----_-De th-------------------- -_---------Li Liquid Capacity----------------------------gals. ❑ Size: Diameter--------------------------- P ---------- ----�., °! Privy: Distance from nearest well___________________________________________ Distance from nearest building---------------------- ________________._. ❑ Distance to nearest lot line--------- --------- -------- ------------------ Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ----------------------------------------------------------------------------------------- •---------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this plication and that the work will be done in accordance with San Joaquin County ordinances, St ws, and rules—and r lat'6 s of the San Joaquin Local Health District. {Signed) ,y� _ --------------------------------------------------------------------------------(Owner and/or Contractor) l'� - (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-- REVI EWED BY-------- ' � ---- ' ------ DATE__/��.__� �4 BUILDING PERMIT ISSUED-------------- ---- ------- - -`-�--------------------------------- DATE Alterations and/or recommend tions:--------- r •----------------------------•. �} -------------- ------------------------.... _ �'_, �- + !----- --------- -- -- - ---- - --- -- - - ---- •-•--�--- -- -- - - , : ,� _ _ _ __ - ______________ ___ ___ - -0�•-•------------ - ------- ---- - FINAL. INSPECTION BY:-R--'- - -------------- Date --------------------------------------------- SA 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 Reviseo 1.57 F-P.CO.