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APPLICATION FOR SANITATION PERMIT Permit No. ----- �7! [Complete in Duplicate) Date Issued --!___ ,__Y S Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins tail.the work herein described. This application is made in compliance with County Ordinance NP. 549:. B ADDRESS A D LOCATION. �f _ ..] ---- -- ----- - ---- -------sit" Y Phone_,--- - bo Owner's Name--- --------------1- - -- - , ° ac ---- Address. �, Contractor's Name '� y r�- --------•---------------------- -----------' one I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Othpr x !Z 'D Number of living units: __/____ umber of bedrooms 3--_ Number of baths __1---- Lot size __ _: -- -- - - ----------------------------------------- Water Supply- Publicfsystem Community system ❑ Private ❑ Depth to Water Table .___T_- ft. PP y' Adobe �ardpan ❑ 1 ❑ ❑ y % Clay Loam Cla Character of soil to a depth of 3 feet: Sand Gravel Sand Loam y ❑ Y Previous Application Made:;;Yes ❑ No New Construction: Yes No E] FHA/VA: Ye El No [r ! TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank'`or`cesspool permitted if ublic sewer is available within 200 felt.)r { P p�,, • Septic nk: Distance" from nearest well__ -Distae� frog foundation___________________Mater I______.___-_- D r Size--------x Ca acs J Nor. of compartments �� X°-S-----Liquid depth = ----- Capacity ---- %i P i Distance from foundation distance to nearest lot lin Dis os I Field: Distance from nearest well4 �� Length of each line----- __--- Width of trench------_- '- -----� Number of lines ---- ------- 9 :--- ?----- � i�epth of filter material_------��---------Total length--------------�u---- --0------------- Ty --------- Type of filter mater --- - ------- -- - i ;; Seepage Pit: Distance to nearest well_______________ Distance from foundation--------- to nearest lot line_______._______._ Number of pits`"""'-'"�ming'mate'rial"^`~ _"5izei"'Diameter_"`_'_"'"""-.--------Depth--------------------------------- Gesspool: Distancfrom nearest well-----------------Distance from foundation._------------------Lining material--------------- ------_____--_ s - - -- _____Liquid Capacity----------------------------gals. El Size:,Diameter------------------------- ------------Depth ----------- ----- _ta ------ ---------------- -A. • `""' �-_r Distance from nearest building_ .________-______ Privy: Distance. rom nearest well--------------------------------- ----------- ❑ Distanceltb`rieares't'lot line ""- =""- �`�`="" ----------------------------------------------I---------------------------------- 1 Remo elingllEand/o re airing-(d scribe -- -----•------ -------------- ---- " ----9-�------------- ---- ------------------ ---------------- . - -------------------------------------------------------- ---•-- ----------------------------------- ---------------------------------------------------- I hereby certify the+ I heave prepared this application and that the work will',be done in accordance with San Joaquin County d rules and regulations of the San Joaquin Local Healh District. ordinances, State laws, an i 1-01 _{Owner and/or Contractor] (Signed) By:--------------------- •------ -- - -----------=------------------(Title} (Plot plan, showing size ofr1o., location of system in relation to wells, buildings, ei., can be placed on reverse side). FOR DEPARTMENT USE ONLY] APPLICATION ACCEPTED BY_ ( ------------------------- ------------ DATE_�------------------------------------------------------- �--------------------------------------------------{ _ DATE----�'- ----------•----------------------------- -------- BUiLD NG PERMIT ISSUE---'----- DATE----- . D-#-----------------------------------------I Alterations and/or recommendations:_______---------------------- ------------------------------------------------•------------------------------- -------------------- ------------------------ ---------------------------- -------------------------------------------------- ------------------------------------- FINAL INSPECTION BY:-___ Date SAN JOAQUIN LO L HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Sheet reeTracCalifornia Stockton, California Lodi, California Manteca, California y. ES--9-2M Revisep 1-57 P.P.CO.