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Permit No. _. .7- APPLICATION FOR SANITATION PERMIT / {Complete in Duplicated Date Issued .- al.- , --- 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. 't°' JOB ADDRESS AND LOCATION ! Phone_ f� tx - .. _ ---------------•--•--------------•- Owners Name-----_-_-!--A�=�--�-_I ---- 'A4 ------------------------------•---...------- ... Address_ - ` -------------------•-------- -------------------------•-------------------------= k �- '- ---------------------------------- --------------------------Contractor's Name___________________________ - ------------------------------------------ Installation wi11'serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other : ____�.- Number of living units: - __ Number of bedrooms -_____- Number of baths _ :-_ Lot size __ I Water Supply: Public system Community system F-1 Private E] Depth to Water Table Adobe Hardpan Character of soil too depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ �, ❑ Previous Application Made: Yes�5�, No ❑ New Construction: Yesf No, FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL___ --Distance from foundation-_____ Mate------- -- No. of compartments_.-_- - __.-_Size__- -- -- -- -:_ Liquid dep+h------ --------------- - Capacity-_.- - Disposal Field: Distance from nearest well_.__--~_.-__Distance from foundation__�-p��istance to nearest lot line----"-- _ Length of each line-------- - ------(�- �°�idth of trench--------2--- -- Number of lines----=--------,-- --- -- 5 2 v�- �---- ------•-- Depth of filter material-_ .'__/f--- g `----4------ Type of filter material-_____j� .___ ------Total length --- --------- Seepage Pit: Distance to nearest ccwell----_--'�'-r"------Distance d a foundation _____=�,...Distag5e to nearest lot line "'-- (�( Number of pits. -off g tj Eze: - Depth � ` _Linin material_ sPI_ .( Diameter--_-- + ----- Cesspool: Distance from nearest well________________Distance fromundation__________-_______.Lining material__-___ els. ❑ Size: Diameter------------------ ------ ---- -------Depth--------------------------- ------- -------------------- --- Liquid Capacity - gals- 0 Distance from nearest well_______________�_ ___.___- -------Distance from nearest building___7-___'__-___---____---____.-___-__-- �.r.r'❑' Distance to nearest lot line--------- ---- - - =------------ --------------------------------------------------- Privy:, { ..-----•------- -------- - Rem deli4L 0yng and/or re airing { Ar describe]:___ _----- ------------- "��-- -- , r - -- ---- ---------------- - --- == ` 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. --------- ------(Owner and/or Contractor) (Signed)C�'li�i 1 tel ^ . ' : (Title) -------------- ------------- i By;----------- - ---------------------- (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----------------------------------------- -------------------------------------------------- DATE ¢! � ----------------------- APPLICATION ------------------- REVIEWED BY ( DATE---.- .- -- ` V = BUILDING PERMIT ISSUED------- --------- , --- --- -f--------------------------------------- ------ DATE--------- -------------------------------------------------- Alterations and/or recommendations------------ -- --- ---- ----------------------------------------------------------------------•--- --------------------- -----•----------------•---•--------•--------------------------•-- - ------------------------------------------ --------------------I------------------------ FINAL INSPECTION BY:.........:... _ Date---��f . ---------- ---� -----------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street $14 North "C" Street 130 South American Street 300 West Oak Street Trac California S#ockton, California Lodi, California Manteca, California ri ES--9-2M . Revisoa 1-57 FY CO.