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rY APPLICATION FOR SANITATIONPERMIT =Perrnit�-�lo. 3' V [Complete in Duplicate] A lication Date Issued ____r1`_�`� pp is hereby made to the San Joaquin Local Health District {ora This application is made in compliance with County Ordinance No, 549, permit to construct and install the work herein described. JOB ADDRESS AND LOCATION:--- -- ham,.-- ------------------------------- " Owners Name_-------- --- -------------------------------------------- --------- --------------------------- ----- Phone. Address----------- ---- - -- ---- �----- ------- -------- �----- ------ ---------------- --- - Contractor's Name------------ ---- ------------------------------ --•-----••-----•--_-_-- ------------------------------------- Phone. Installation will serve: Residence [Apartment House El Commercial Number of living units: �_-_ Number of bedrooms -_� El Trailer Court E] Motel ❑ Other E]- Number of baths _�-- L`ot size ___ 6_ Watef Supply: Public system A-pfd Y �Community system ❑ Private ❑ Depth to Water Table _Ydp,it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ I No [r New Construction: YesNo TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ W?' FHA/VA: Yes [] (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) \ Segtic Distance from nearest well-----------------Distance from foundation----------------- No. of compartments-------- Material -------------------------------------- I Size_ Liquid depth--------------------------Ca act ______________ ______ bis osa Field: Distance from nearest well._. `Distance from foundation--____ p I - /�-----_____Distance to nearest lot line___ Number of lines__t-----�---�------------ -Length of each line------- ---`---- --- ---- ...Width of trench. r2_' d�------- i Type of filter material__ ,Depth of filter material_-_.�-6/ Total length �Qp------7 -�- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________ \ ❑ Number of pits---- ----------------Lining material---------- -- ---------Size: Diameter-----------------------Depth Cesspool: Distance from nearest well-----------------Distance from foundation____-___-____ F ❑ Size: Diameter----------------- Lining material------ ------------------------------------- ---------------- - -- -- . Depth -------------------------------------Liquid Capacity Privy: Distance from gals. nearest well________________- --__ Distance from nearest building------ ------------- ❑ Distance to nearest lot.line ---- -------- . �, - I Remodeling and e /or repairing �describ` ---------------------------------------------- ----------------------------•-----•-----•-•---------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance"with San Joaquin County ordinances, State laws, and rules and r`e ulattons of the San Joaquin Local Health District. r (Signed - --------------------- r I t �L ----tract i or C or) -=----(Title) (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -� REVIEWED BY "-------- ------------- ------------ DATE-- --------------------------- --- ----------------- ---- - a ------ ----------------=------- DATE BUILDING PERMIT ISSUED -------------------------------–-------------------------------------- �c - Alterations and/or recommendations:---------- DATE.__._" __ ---------------------•--------------------- --- -- -----------------------------------------------------•---------"-----------------"-- ----------------------------------------------------------------------- --- -- FINAL INSPECTION By------- ---- ---- - Date"__ ___..__ - - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americart Street 300 West Oak Street 132 Sycamore Street Stockton, California14 North "C Street Lodi, Californiaelifornie Manteca, California Tracy, California ES-9-2M , Revises 1-57 F..P.CO.