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APPLICATION FOR SANITATION PERMIT Permit No. __ -a,-'_ r� !1 (Complete in Duplicate) Date Issued __��-7/•r� Application is hereby made to the San Joaquin Local Health District for a permit to constru d in all the work/herein described. This application is made in compliance with Count Ordinance No. 549, C3�© �`- fF��•f-f'cJ�4- � - �J � -cam.` JO ADDRESS AND CATIO ._ -` v Owner's NameU--------- ------------------------------ one---------- Address-------- - ---------------•- ® � Contractor`s Name--------------------------------W"I" - ----------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Truuaille-r;�-�Court ❑ Motel ❑ Other [� Number of living units: ________ Number of bedrooms -------- Number of baths -(-_""--Lot size ------------------------------------------------------------ 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 ❑ Clay [] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2----New Construction: Yes [Er`flo ❑ 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/69_____f_Qistance from foufndation__-3/P_._1_--------Material----S._-z�__, 51 � No. of compartments---------c�--------------Size_____S71__7_3-iQ-----Liquid depth-----YX ----Capacity----SW_ / / Disposal Field: Distance from nearest well_,1�.__-___Distance from foundation___,�-__e________Distance to nearest lot line_ _______ Lam" Number of lines------/___ __________-__- _ Length of each line--g-e!-______________-Width of trench____2_�y---____________ Type of filter material S__- Depth of filter material____�,V'r_______Total length-------;�-Q-!____________________ J Seepage Distance to nearest welllf/f --------- '9 from fou dation___yd_-y_-____.Distance to nearest lot f ize: Diameter-_____ _ p Number of pits Lining materiaL _f�' � ----Depth 1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- -© ' ❑ Size: Diameter------------ ------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. C, Privy: Distance from nearest well_______________---------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------ -------------------------- ----------------- Remodelingand/or repairing (describe)--------------------------------------------------------•------------------------------------------------------------------------------------------------- ------------- ----------------------------------------•----- ---------•--•---------------------------------------------------------------------------------------------------------------------------------------- ------ ---------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------------- ------ fi -------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------- I hereb(cert y that I have prepared this applic tion and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules andgrulation of heSan oaquin Local Health District. .. (Signed)--------- ' '"---- ---- --------------------------------------------------V-. -_-__O )wner and or Contractor T. (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 - --- ------- 17 ----- DATE REVIEWEb !3Y - -- --- F----- --- - -------------- DATEf,;,^' --- - ------- - ---------------------- BUILDING PERMIT ISSUED---- --------------- ------- �'------ - ------ -- - -- --------------------- DATE - - ---------------------------- Alterations and/or recommendations -------------------- - ---------------------•-----------------------•---------------------•-----------------------------•----------- ----------- ------- --- - --------- ----------------------------------------------------------•-------------- ----------------------------------------------------------------------•---------------- - --- - ---- ------- -- ---------- - ---- - - - --•----�_:-- -------- - ------------- - ``- -�" ----- - - - ---}*`I"l -------------------- - -- --------------- --------------------- FINAL INSPECTION BY: ---------------------------------- Date.-------- ----------------------------------- /�/ - ----_---------------- --------------------------------- 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 ES--9----2M , Revised 1.57 F-P.CO.