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, :�- 0/f APPLICATION FOR SANITATION PERMIT Permit No. ? " (Complete in Duplicate) i - �_ �"-" _ .:9��_- •_�-7 Application is hereby made to the San Joaquin LoDa+e Issued cal Health District fora permit to construct and instali t This applicafiorf is made in compliance with County Ordinance No. 549. he work herein described. JOB ADDRESS 'ND r OCAT;ON - ---------- ------Owner's - Name -- - -- f Pone Address____--�`-'�-- •- ' - --t.. ------------------------------------- ------------ --------•---- ------------------------------ ---------- ----------------------------------------------------- ------- ontractor's Name___ . ___.__ ------------- --------------------•--------•-------•---------------------------------- Installation will serve: Residence Apartment House � Commercial E] Trailer Court Phona____________________ ❑ Motel ❑ Other ❑ Number of living units: _;��=unify er of bedrooms _- ?.t__ Number of baths ___ ___ Lot size _______ ------------______________ ___ Water Supply: Public system ' s stem - ! -- Y� Y ❑' Private ❑ Depth to Water Table -------- ft. Character of soil fo a depth. of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe 2--'Hardpan ❑ ❑ No New Coh✓ nstruction: Yes NNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank er'cesspool permitted if R s wer is available within 200 feet.) r Septic Tank: Distance from nearest waft_ .es �— i ___-Distance from foundation-` - r ---------Materi I LI No. of compartments----_-- Size_ ,]_ --- --- --- a c� Liquid dept✓y '. - Ca acit --Q Dispos�d'Field: : Distance from,,nearest w l!_ r p Y foundati n _- - • Distance from Q �� ___-_ ____ pistanee to nearest lot line:__._ tj -Dengthoff filter lined' 5'.?foS-�D'Width of trench--_-- '�- Number of lines_- :--_-__ _ Type of filter materi = �l -__-__-_____ ff Y ------- p material- - +t- Seepage Pit Dis#ante to nearest well-------- Total length---.------J- r- --------------- ---- �wxe !Fe-,�.,.. f Distance from foundation----------" _'___:Distance to nearest lot line_________________ _ ❑ Number of pits------ --_- --- :=--Linin material--------------- ------Size: Diameter.---•---•_---- 9 ---------Depth------------- ---------•- Cesspool: Distance from nearest well__--°_____-__- __Distance from foundation_--- __,___--Lining material________________________ __ _____•_, ❑ Size: Diameter---- r --- --- Depth---- - I :Liquid Capacity--------------------- gals. Priv _-__. Y Distance from nearest;well-------------------------------- -- ----__-.-Distance from "nearest building---------------_ ❑ Distance to nearest lot line` -='---------- -------- ,..x. . -'�: --- •--------------------------•-- - W-._ - RemodelingJJ and/or repairing (describe) j ---- --- x�+ ------------- ----- --- -- --- Vii? '�"'� �sa '�t• l �. ! - ---------•-- --- ` --------------------------- -------- --- - ) - ------ ---•--•-- ----•--•-•-----------•------------------- -------------- =- --- ---- - • ------ ----- -----•---- - ----� -- --- --- -- ------------------ -- I hereby certify that I.have prepared this application and thaf the work will be done€in accordance'with San Joaquin County ordinances, Sfate aws, and rul d regulations of the San Joaquin'Local Health District. {Signed) - s v------------------- , -----(Owner and/or Contractor) --------------------------------------- -------------- --------(r+le)--------------------------------------- (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_ --------------------- - - ---------- ----- DATES ----REVIEWED BY------------- - -- _ -----------------•------- - '--- - ------------------------------------------------------------I --- DATE ---------------- BUILDING PERMIT ISSUED.:____ _-'-------------------------------- - = DATE ------ Alterations and/or recommendations:__.`s------------- � -------- ------- -------------•-----•-----------:------••------------------- ------------- --- -�--• f. -�' 1 £ _ - ------- -- --- --•- ` -._ -------------- --------------- ---- - - - - f__- � S ---- ------ `�'�' -------------` ' f�11 �� ` ---•----•-----------•------- FINAL INSPECTION BY______ _ ---- --------- Date--- ------ ---------- - - -------.� -�- ----"=----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 West Oak StreetF 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M , Revised 1.57 F.P,CO.