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t t.�. APPLICATION�FOR SANITATION PERMIT Permit No. L? ----- ..... (Complete iniDuplicate) 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 Ordinance No. 549. JOB ADDRESS AND LOCATIIOON----- ----- ----------7---------' "` Owner's Name- l -- - ------•_� ' i ( '4 _ --------------------------------------- --- ----- ------------ Phone - AddressfF .�_ ----•-••-------------------------------------------------------- Contractor's Name-__- �-- Phone----------------------------------- ----------------------------- Installation ---------------------------- f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer. Court ❑1 Motel Other {] i- INumber of living units: '-- -.-- umber of bedrooms _ Number of baths --]---..Lot size __-��-x �� --•------•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .:' -_-_ ft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe ardpan ❑ PP Previous Application Made: Yes El No [+ New Construction: Yes [ No E] FHA/VA: Yes No,[► 1 TYPE OF INSTALLATION AND.YSPEC.IFICATlONS: � E (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` Septic ank: Distance from nearest well------------------ from foundation-------------------Material------------------------------------------------- Nc..of compartments-- - Size----------------------------- -----------1------'-Capacity-----=----------t----' ) - Liquid depth -- '�yN`/ &4ADistance from foundation -�_-f�oistane Lto nearest lot lin(3.7---c__---___- Disposal Fie!-F Distance from nearest well--- .-.-`_._ ' Number of lines--__.-----: _- .___----__Length of each line_---_-_-- _ _t*- "Width oftrench----- ±- ''__ '~. � _ Type of filter material ' -� Depth of filter material------ �� ---__---Tota4 ileth-----•----•1-- - --------------- _, ----M__..Dista�nceio nearest lot line----------------- I Pit: Distance to nearest well-------------- Distance from .foundation___-_-_._ �❑ 'Number of pits----------------------Lining material-----------------------Size: Diameter------- :---------I---Depth------------------------•-----•-- Cesspool: Distance from nearest.well-----------------Distance from foundation-----------_-.-----Li'ing mCaaacitaterial__ __---__----.-_--.--.----_--------.`--------------------------- ;. Liquidals. .,•.❑ Size: Diameter-'- - =-=------- ----------------Death---------------------- ------------------- ---- , Privy: Distance from nearest well--------------- --------------- Distance from-near-'V+ ---------------- ------------- Distance to nearest lot line'-- r-=-----------------------"---------=--='--------=---------1____'=-'----------- ---- -------- ------ 4 Re odeli g and, or .repairing (describe)---r---�-- -- --------------� ----- ' --------- ------------- .. -. '= ---•------------ ---=-------------��-------------------------f--------------------------•----- ------- --•----------------------- ------ ' -------------------------------------------------_------------I------=------ ------•---�-------- --•------------------•------------- kS--•-----------------------------•----------------------------•-.----------------------•--------••---- --------------------- ----------- ------------------------------------ \I - I hereby certify that l have prepared this application and that the work will be done in accordance with an Joaquin County ordinances, State laws, and rules and regulations of the e San Joaquin Local Health District. r {Si nedf 9 )r - I------------ ---------------- (Owner and/or Contractor) By:-------•------------------------------•--- --------------------- - 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'7- ------ ---------------------------------------------------------------- DATE--!Z,,: - --------------------------------•--------------- REVIEWEDBY-------------- ------------ ------------------------------ ----. DATE- BUILDING PERMIT ISSUED - - ------- DATE.- !" Alterations and/or recommendations:-------------------------------------- --------------•------ --------•---------------------•----••-- ----------------------•-------------•---------- •-•-=--------------- ----------------------------=----- ---•------- ---•-------------------•----------••----------------------------------------- ' -------------------- --•---- .--------------• --------------------------------------------------------- - - ----------------------------------------- - FINAL INSPECTION BY:-. ------------------ - Date------- 1 T}= SAN JOAQUIN LOCAL. HEALTH DISTRICT i 130 South American Street 300 West Oats Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Revises 1.57 F.P.CO.