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II Cf`�► APPLICATION FOR SANITATION PERMIT Permit No. ________________________ 1i�y" i F (Complete in Duplicate) �p f -- � Date Issued o Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATI N_____ s V` �l y 3� am �c.� 3 ---- -------- ------------------------------------------------------------------------------ Ll Owner's Name------------ '----- ---'�U, cLY Phone -------- Address � Q � --- ----=----------- •------------- -- Address----------------------IN-_f------- ...... ------------------------ Contractor's Name ----------------------------------------------------------- --------------------------------------------- ----------------- Phone_--------------------- , Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units ]--- Number of bedrooms __ Number'of baths --- __- Lot size __- )--------------------------------- Water Supply: Public system [ ommunity system ❑ Private ❑ Depth to Water 'fable .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction:iYes No ❑� FICA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cessrpool permitted if public sewer is available-within 200 feet.){ ba 1 Septic T Distance from neares welj-___.Distance from f�ndation____/ __________.Material____Ra - No. of com artments2/�^ ______Size-4 _=__Li uid de .th-___-`/-----------------Capacity-----91------ - 1. • - - = C I Dis osal .ieid: Distance from nearest'welE ____ Distance from foundation____ _� Distance to nearest lot lifre__�_________ liy+ - Number of lines------- ___-- Length of each line---------- Width of i<01 gl_ _____ __ __ � • Type Iter material-__&QC ---------Depth of filter material__ _f-3__-________Total lengt _ ___ _ Seepage Pit: Distance't1 in V li , T e o Io nearest well______________________Distance from foundation-----______._-------Distance to nearest lot line----------------- 1 ❑ Number off pits----------------------Lining material-----------------------Size: tiameter•---------------------.Depth-------------------------------- L 'u i 1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- F1 e: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----•----------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building--------__-_____________________________- , ❑ 'Distance to nearest lot line_____--___________________ - --------------------------------------------------- ---- --- ---------------------------------------------- 9r 'i Remodeling and/or repairing�I describe :- -------'----------------------- ---------------------------------- -- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------•--- -----------------------------------•------------------------------------------------------------•------------------------------------------------ I hereby certif hat I he prepa d this application and that the work will bedone in accordance with San Joaquin County ordinances, State a ul and r gulations of the San Joaquin Local Health District. ! ' � (Signed)- `------ ---------------------------------------------------------------------- -------------------(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). S llf II FOR DEPARTMENT USE ONLY IF I APPLICATION ACCEPTED BY----- A ---- -------------- DATE--- - - - - ----- ----------------------------- REVIEWEDBY------------------------=1 '�. --------------------------------------------------------- ----- DATE---- ------------------------------------- BUILDINGV--------------------------- - - ----------------- BUILDING PERMIT ISSUED---i------------------------------------------------------------------------------------------------- DATE------------------------------------------ --- -------- Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ II --------------------------------------------------==-------------------------------------------------------------- ----------------------------------------------•------ ---------------------------------------------------- il -----•--------------------------------------------------------------------- --------- --------------- ----------- --- I. ----------------- ---------------------------------------------------------------•--- n J'� 0— FINAL INSPECTION By... 'h � = .__ Date== 1.- 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 E5-9-2M Revised 1-57 F-P,CO. �j