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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate Date Issued ___��/�� 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 dinagc(No. 549. JOB ADDRESS AND1 CATION------ --- ------------------------------ --- --- l - - ---- ----- Owner's Name ►►yy 1 4� `� - ----------------- Phone--- '�' Address---------------------------- Contractor's Namek4.fi r-------_ A-Z-1S----------- ----------- - -------- Phone.------------- ------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --t----- Number of bedrooms __2---Number of baths A____ Lot size ----- ---_f 6 O 1 Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: S7New Gravel ❑ Sandy Lo;--PNo Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Construction-. Ye's ❑ FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if ic sewer is available within 200 feet.) Septic Tank: Distance from nearest well---I�_V( Q�Distance, from,fo ndation____-1_0--. Matprial I LJ No. of compartments------�----_-_-.--Size__ _X_ ?C -------Liquid depth----4--_______________Capacity___ eQ 1 Dispos I Field: Distance from nearest well---__._ __�-0istance from foundatio .---I-P----------Distance to nearest lot line---- S. .... Number Number of lines-----Z---- ------ -------Length of each line------ C---'-----------Width of trench-----a(----------------------- Type of filter material-___FGC V-----Depth of-filter material----t-9-------------- I otal length ❑ -------_--------------Ditance from foundation--------------------Distance to nearest lot -line --_-_-_-_--Seepage Pit: Distance to nearest well Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --------Depth--------------------- e th---------------------_--_--.--_-_-----_--_--_--_------ Cesspool: - - Distance from nearest well----------------- from foundation--------------------Lining material_____________________________ ❑ Size: Diameter----- ------------------- -----------Depth------------------'--------------- Liquid Capacity gals. Privy: Distance from nearest well ____,_----- .__:-------------------------_____Distance from nearest building ❑ Distance to nearest lot line----------------------------------------------------------------•------ Remodeling and/or repairing (describe):--------------------------------- ---------------------------------------------------------------- -------------•--------------------------------------------------- lv - ---------------------------- ---------------------------------------------------------------- --q----------------------------•------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, State la s, and r es and re tions of the San Joaquin Local Health District. (Signed)---t----- . ------ ------ ---------- -- ----------------------------(Owner and/or Contractor) -------------- BY=------------- - - y Title _ ------ -------- ------- -------------------------------------------------------- - ------------------------------------------------------- - ot pan, 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---------------- y-- - -------_ - - DATE-------- ------- --- -- -------- --------------------------------- REVIEW E:D BY------------------------------------------ -- -- - - - ----------------- ------ DATE------- - - ------------------------------ - - -------------------------------------- UILDING PERMIT ISSUED---------------------------- -------------- ---------- DATE------------- ------ Alterations and/or recommendations:--------:__________- { -------- =_ -------------------------------------- ------------------------------------------•-----------------------------------------_----------------•------•---------------------------------- --------------------------------------------------------------•I-------------------------------------------------------------------------- FINAL INSPECTION BY--------- ------------•--------- ------------------- Date---- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-2M , Revises 1-57 F.P.Co. '