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7� -�- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __!�K/s�_ 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 wi County Ordinance No. 549. %�fcr,Ji9-• z,6 ff B ADDRESS A. D LOCATlO -- -_-_-. _- - C Owner's Name---- - j r --- -- -------'�_x_ Phone Address..----•----•------ _ --- ,�. ---- ------------------------------------------------------------ ----------- Contractor's Name----------- --- - - ------------------ Installation will serve: Residence Apartmenf House ❑ Commercial 0 Traf:l-'court El Motel El Other ❑ Number of living units: - - Number of bedrooms - _ Number of bathsq- i ------ Lot size .----- Wafer Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table _�c�ft. Character of soil to a depth of 3 feet: Sand - Gravel E] Sandy Loam El Clay Loam [] Clay E] Adobe�rclpan ElPrevious Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: r� (No septic tank or'cesspool permitted if ujvlu�gisfance e r is available within 200 feet.) ,p Septic T Distance from nearest well_/+� from foundation- ---4-----•---.Material--- � . / ------- No. of compartments- / / p Size__S *-- Liquid dep`h_ - �•?- 6 ------Capacity-.&f . --- N , Disposal field: Distance from nearest well_---_--.-Distance from foti�j�_ istance to nearest lot liner---------------- Number of lines---------- __ ---*�-------- Length of each line ............ �--- ----Width of french------- -5f-------------- Type of filter material-- 1� - _Depth of filter material---�_F-__----- .Total length----- -___-_. Seepage Pit: Disfance to nearest well-- _: ___---_ -__-_ islance from foundation-------------------.Distance to nearest lot line_----._-----__--_ ❑ Number of pits----------------------Lining material--------------------...Size. Diameter-------- � Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------`_----.Lining material-_-_..-_---_-_ ❑ Size: Diameter-. .; --------------- -------Depth----------------------- - r. -----------------L,quid Capacity------- gals. Privy: Distance from nearest well__--1- ,------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line-------------------------------- ----------- 9 Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ --------------------------------------------------- ------------------------------------------------------------------------------------------------ ------------------------------------ --------------------------------------------------------------------=-----• -- t ------------------------------------I------------------- ------------------------•----------------------------- -------------------- I hereby certi y that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, S+ la s, and rules a egulations of the San Joaquin Local Health District. : IS� ned I 9 ) ----- -- -- ----- _ ---- ------- ----- ------------------------------------------------------- IOwner and/or Contractor] By:--•---------------------------------------------- `P' ----------------(Title)--------- -� ---- ------------- --- --- (Plot plan, showing size of lot, location of system in rela+' n to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- DATE-- - - - ---- ------------------------ REVIEWED BY --f- 4 ------------------ ----------------- + --- ---- ---- - ----- DATE-- ------ ----- - - ---------------------------------------------------- BUILDING PERMIT ISSUED ----------- ------------------------------------------- ------ ----- DATE------------------------------------------------------------ ------------------------------------------------------------ and/or recommendations--------------------------------------------------------------------- ------------------------------•-------•------•----------------------------------- - ---- --------------------------NvLe - --------------- -- --- ----- ---- ------ -------------------- as�r ------------- - ------------------------------------------------------------- ----- ---------- ..._ G a FiNAI_ INSPECTION BY:------ ------ -----____-- ------- 7 /a-- ----------- Date--- - --------- 3i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Street 914 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M . Revisea 1.57 F.P,CO. l