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_y rJ f APPLICATION FOR SANITATION PERMIT a. Pk No. .___��__.C__��._ / cateCom (Complete in Du-plicate) � p p• ] bate Issued Application is hereby ,made to the San Joaquin Local Health District for a permit to construct and insta I the works herein ascribed. This application is m•-de:in compliant County Or ante No. 549. 1-2 77,. , Tge JOB ADDRESSUNI<OCATI - (f/f -6: Owner's Name--------- - -- - -- --- ---- ------- -------------- { P oh nem Address---------------------------- � (V,- -------------------------T------------------ ---- ------ ----- ------------------------------------------------------------------------ J_ Phon ------ Contractors Name - --- -- --- � jrT= r Installation will serve: Residen e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living'units: __f.. Number of bedrooms �!_ -_ Number of Baths ___ _ LOt size ._.__ _________?�._.__fQ -- IWater Supply: Public"'system '❑ Community system rivate'❑ Depth'to Water Table t.. 1 Character of soil to a depth of 3 feet:: Sand Gravel Sand Loam Clay Loam Clay Adobe ardpan ❑ ❑ Y ❑ Y ❑ Y ❑ � ❑ Previous Application Made: Yes El No c New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or'cesspool.permitted if pu is sewer is available within 200 feet.) ` Septic T Ilk- Distance from nearest well Distance from foundation O Mater' ? . = No. of compartments---- __--Size_ }�__ _____1�Li uid de th_ i -------------Ca acit , Disposal Field: Distance from nearest well____-.y-_ .. Distance from foundation___ tV_'.-------Distance-to nearest lot line Number of lines----_`- _ __ ..._ �j_ � Length of each line_____ _ s®_ Width of trench. __ Type or filter materia _14rt�_:_'.Depth of f'ter mate ria ? d_ .__Total length----- ---- !!! ^�. Seepage Pit: "Distance to nearest well_-��___-__Distance fr foundation__--�-5-` - ..Dist ce to nearest lot line__ / [� Number of pits----- .__-___-_Lining materia- - ------- Size: Diameter____ Pn� p �� V ------..De th- --� ------------------ Cesspool: Distance froml nearest well---------------"-Distance from foundation--------------------Lining material_---__-----.---.---.----------------_ ❑ Size: Diameter-------=----------------------------ti Depth----------------- --- -----------------=-----------Liquid Capacity---------------- ---------gals. C Privy: Distance fromllnearest well_____________ ________________________.____=__Distance from nearest building-----._-----_---------___-_-_.---_-.----. ❑ Distance to•nearest lot line ---- '.' ------------------- =--------------------------------------------------------- T� {� Remodeling and/or repairing (decribe)------------------------------------- ------------�---------------------------------------•----------------_-------------:-------------- ---------=----------•-------------------•-------=-------------------------------------------------------------------------------------------------------'------------------------------------------------------------------- --------------------------------------- -•--------- �11---------=--------------------------------------•--•-•---------------------------------------------------------------------------------------------------------- • -----------------------------------------------------••-=----------------------------- ------------------------------ ------------------------------------------------------------------------------------•--------- ------ I hereby certif that ( have P spared this ap kation and t the work will be done in accordance with San Joaquin County ordinances, Stat s, and rules nd r ulatio of -San J aquin Local Health District. i r (Signed) ---------- -- ---- -- -- - ---------------------- Contractor), -- ---- ---------------- ------- ---- ------------------------------------------------------- y-------------------•---------•-_----------------------------------------------`------------------• --• -------- -(Title]- >< (Plot plan, showing size of lot, location of system in relation to w T1 uildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY = = ------------ ------- DATE.��-�'.; --•------------------------------------------------ REVIEWED' BY----------------------------- --- = ------ DATE-- BUILDING PERMIT ISSUED------- - - A ---------r�eA --- - --------------------------------------•-------Alterations and/or recommendations:-:..;Z/��_ _�-�.c�e'�� 5-- ��+___________ ------ -------------------•-----------------------t ----------------------------------------- -------------- ----------------•------------ ------------------�------------------------------------------------ - - - -- ----------- ------------------------ ----------------- ------------ --------------- --------- --------------- ------------------------------------- --------------------r-----------=-------- = Date --_...-- - ------- FINAL INSPECTION BY=------ ----- -- ---=--- ------ - -------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT / 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-2M , Revised 1.57 F-P.CO.