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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ._..✓_._.... __S • .2 SS- 3�o �23 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 with County Ordinance No. 549. 1:3JOB ADDRESS ,NDCAIO � t ' N•------••--. At/ . Owner's Name ------ _----•------••-••--•- ................ ........................................... .................... Phone.---....................... Address....... rrZ 111.r t�. r -------------•-•---------_..---------------•-----------------•--_-------•_-----•----•----•---•--- Contractor's Name........ � .................. ................................................................................... Phone................................... Installation will serve: Residence 19 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 11Number of livingunits: -1..... Number of bedrooms _ Number of baths _._ ... Lot size ...: ...... 11. Water Supply: Public system [3Community system E] Private M, Depth to Water Table�W. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay CY Adobe❑ Hardpan ❑ Previous Application Made: Yes p No 5� New Construction: Yesx No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well._.-„,�._v-.Distance froom foundation__.. .......Material __.C�. '-' , `r�'-�D--•--, t o. of compartments-__-_!2,....-_---_.._.rSize___ :►C__y_.x_._. iquid depth............ Ca p a c i - .. Disposal Field: Distance from nearest well._. .0__..Distance from foundation_...;?_.—. Distance to nearest lot line-...�._. fe ber of lines.__.__- ._.____ ._._I_Length of each line_._.__ Width of trench.. _ _ _.. �r ,,r K of filter material._ _I--?_P1Depth of filter matenal_.._.�...._._.___-_Total length_._..__- - <.....----------- __............... 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__..................Lining material.................................. El Diameter Depth. ...........................Liquid Capacity....................... .....gals. Privy: Distance from nearest well----_........._..................................Distance from nearest building------------------------------------------ F1 Distance to nearest lot line............................ ................... .........................................................-----••---•-------------._.._.. �. Remodeling and/pr repairing (describe):__. __ �t..d, __ -V. ! -.! � ---- -- ::__ -' - -�. --------_- ••. . ..._.. ............................ --------------•••••••--....... ------ --•-----•--•. _...•--•-------___..._..----._.__.-_----------•--••----------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Si9 ••---- ........ . .........................•-•---------.................... ------------------------------(Owner and/or Contractor) By:..... ----------------------------•-------------------------------- -------------------------------------------------------(Title)------------------------------------------------------ ------ (Plot plan, showing size of lot, locafiion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.----... DATE.......................... REVIEWEDBY-•-•••-•••............................ +? ............................................. DATE---...-...= BUILDING PERMIT ISSUED................. ._...................................... DATE......... _.__.._. Alterationsand/or recommendations-------------------------------- -------•--__...._.._...-•-..._._____----..................................................................................... -----•-•----••------------•--------------•---•----•__----•---_-__--••----•----------------------------••------•-----------------_-_--------•---------_...__.._..._... / ..--•----•---••-•---•---------••--••••----••--•--------•--••••-••-•••---•------------•-----•-------••-----•-•---•--------•--•-•---•-• -•--...-----•------•-------------•-----------------------------•--- ....................•---•-......-•••••--••-.......-•--•---•---•----••-•--••-•-•--•-........._...----........_.....•-•-••••--•-..._.__..........--•-•---•------••-•-....---••-------•----......_......._... .......................................................... FINAL INSPECTION BY%.._� .... ............. -_.---._____--_---- Date............................../•�-- � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1-57 F.P.CO.