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I APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _ 7147f Application is hereby made to the San Joaquin Local Health District foraer:��it to construct and i This application is made in compliance with County Ordinance No. 549. p �I install the work herein described. -_____.__ JOB ADDRESS AN LOCATION.---- -sl____ _ --- ---_ Owner's �/ ... -------- ------- --------------------.------------•------------ ADDRESS ANYOwner'sName _ Phone --------------- Address--------------•------------ -------------------------- -- - Contractor's Name--------------------------------------------------------------------- Ih ----------------------- Phone ---------------- Installation will serve: Residence IX Apartment House ❑ Cgmmercial ❑ !Trailer Court ❑ Motel ❑_Other ❑ Number of living units: __1.__ Number of bedrooms-b?---- J�ml5e—r r Nmssi�er of baths' ._-- Lot size -7-r __/ _--. -_----- Water Supply: Public system Commun'it system ❑ p I y y ❑ Private Depth I,to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ I Clay Loam ❑ Clay ❑ Adobe E�,Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No FHA/VA: Yes ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_______________________________________-________. [ %fi No. of compartments------------- ------,,-�--j--Size------•-------••--------•-------Liquid depth------------------------._CapacitY =_ Disposal Field: Distance from nearest wellfs" Distance from foundation_-__ -�- o -.Distance to nearest lot line___ Number of lines----------�-----� - ----- Length of each line----,.�f� �--------_--.Width of trench-----4,--r�-- ------------ I___/of filter materiaL___li" -Depth of filter materialG_1 _r _____Total length.__ -- ---------------- r Seepage Pit: Distance to nearest well_ -_ --__Distance fro fou atian______. _ �' -6 [�_-•.Dp'stan�e to nearest lot line__�__- Number of its._ _ t p -/---------------Lining material_- e - _ds _-- ize: Dlameter_ex_A _ �_Depth---16------------------------- to, f"� Ge . Distance from nearest well________________Distan a rom oun tion--------------------Lining material_____.--------------------- ------ ElSize: Diameter------------------------- ------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________________ ____________Distance from nearest building ❑ Distance to nearest lot line___________ Remodeling and repairing (describe):-------- __________ -- --„•---_---•---------'I- --------------------- --- _ -----------------------•-------------...------•-•----------•-------------------._--------•----•-----------•-----------------------------4---------•------ -------------------------------••----------- ------------ --------------•-----------•-------- . = •-------- 11 -------------------------------------------•--------------------------------------------------------------------------------------------- - ------•--------------------------•-----------------•-------------------------- -- 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. - -- 7 (Signed) ------------------- --------------------------------------------------------------------1 -------------------------------------(Owner and/or Contractor) BY:------------------------------------------------------------------------------------ -----------------------------------�-----------(Title)--------------------------------------------- - ---------------- (Piot plan, showing size of lot, location of system in.relation to wells, buildings, e1c., can be placed on reverse side). n FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--------- •-- ---------------------j------ -{ DATE- ✓�,i - -- - ------------ REVIEWED BY__----- � DATE_-- BUILDING PERMIT ISSUED. ------- - ----------- -----------------------------11----------- DATE------- ---------------- ------------- ----- -------------•- aerations and/or recommendations:------------------------ __----__ 14 ---------- ...... LOA----- i� 1. ? t .Q --------------------------------- _ -------------------------- -------------------------------------------- I ---- FINAL INSPECTION BY:. ------- --------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT `' 11 130 South American Street 300 West Oak Street 132 Sycamore Street SJ4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--•4-2M . Revised 1.57 F.P.CO. !�