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APPLICATION FOR SANITATION PERMIT Permit No. ___ - - -- A (Complete in Duplicate) / Date Issued --- Q Application is hereby made to the San Joaquin Local Iiealfh District for a permit to construct and install the work herein described. This application is made in compliance with CountVdLinancoN x/549. JOB ADDRESS-TD LOCATION f ---------- .'. h Owner's Nam ' _.• `f � ' `f � ss. ---- ------------------- --------------------------------------- Phone. � Addre _ ° `' l�` --------------------------------------------•----------------....------------------------------------- Contractor's Name--- ------ --------------------- - ------------------------------------------------------•- ---- Phone----_------------- ---------.----- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Mote) ❑ Other ❑ Number of living units:�-__ Number of bedrooms ___LNumber f baths ._1-_. Lot size __I�.O_-x �---__------------------ Water Supply: Public system E] Community system [-] Private Depth to Water Table .----- ft. ❑ [ICharacter of soil to a depth of 3 feet: San ❑ Gravel E] _ Sandy Loam Clay Loam Clay Adobe Hardpan El Previous Application Made: Yes ❑ No New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ PE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if blit)ewer is available within 200 feet) Septic Tank: Distance from nearest well Dista e,ufro. ounaion____ No. of compartments---- ------ Size-_�_ _ .--------Liquid death-------.-------------------Capacity- -x ----- �'��`� Distance to nearest lot lin Length of each line-------- ---- fr----- ----- Dis osal Field: Distance from nearest well_ Distance from foundation--_---. �_... __.* Disposal -- Number of lines----------- --____--r-�_-.-- � _ ----Width of trench-____-- .- _-- Type of filter materiC ' Depth of filter material-------- _._____Total length--------------h2P-------------- XP _-- --_-- -E Seepage Pit: Distance to nearest well----------------------Distance from foundation___...------------.Distance to nearest lot line-_--.-_.----_--__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------. 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------------------------------------------ ❑ Distance to nearest lot line-------- --------------- a i Remodeling and or re airin describe i ---------------------------------------•---------------------•------------------------------------------------- ----------- ------------------------------------•-------------------------- --------------------------------------- --------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. ' # � ------------------------ caner and/or Confracts ; 4 ' (Signed)_ s _ e► = ------------ (O ----------• --------------- ----------- --- 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 APPLICATIONACCEPTED BY- �--- - ------------------------------------ DATE�------------------ --------------------------------- REVIEWEDBY = ---------------------------------- --------------------------------------------- DATE_ . BUILDINGPERMIT ISSUED-------------J-------------------- - --------------------- ------ DATE-------��---------------------•------------------------ Alterations and/or recommendations---------------------- ------------------------------------------------------------------------•----------------•---------------- •-------------- ----------------------------------------------•------------------------------------------------------------------ ------------------------------ -- x-------- --•---------------------------------------------------------------------------------------------------------- --------------------------------- _..--- �-------------- -------�- Date----------------- � —7 FINAL INSPECTION BY:------------- - /11 -_ i SAJOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 W sf Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 V CO.