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{ ;oJ c6rf5 ¢. Permit No. APPLICATION FOR SANITATION PERMIT ....... -3; vo (Complete in Duplicate) Date Issued ------------------- Application 6------Application is hereby made to the SanJoaquin 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. • JOB ADDRESS AND LOCATION--------'--`�---- - . , ='--- =-----�'---:--•----=_---�------�`'C=-=---------:-- Owner's Name......... -cf ,._ ----- Address_" f 1 �: :�.-----� 4T -------- ------------------- e? -i .... --- , � -- -- ---- -- - --- ' ' - /�_/1!'�.z +. -- -- Phone. =� ' Contractor's Name-----------=------• -------� ��-- •• ------------•------•-- Installation will serve: Residence Apartment House ❑ Commercial '❑--Trailer Court ❑ Motel ❑ Other ❑ f c c j` /� ---------------- Number of living units: _/___-'Number of bedrooms ____ Number of baths Lot size,__-__ •_ Water Supply: Public system ' Community system ❑j Private E] Depth to Water Table�_ !t. Character of soil to a depth of 3 feet:-Sand El �Gravel [j—Sandy Loam El-'Cla'y Loam El' Clay C] Adobe 0 Hardpan ❑ Previous Application Made: Yes El No New construction: Yes ElNoo FHA/VA: Yes ❑ No [I 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-----------------Distance from foundation---_-------------- aMaterial ____.___--_-..______._-_.__-______________._- No. of "compartments------------ -------------Size----------------------------:---Liquid depth--=------------ ------ Capacity----------------------- Disposal Field' Distance from nearest well-------_--------__Qistance from foundation--------------------Distance to nearest lot line___--_______-_-.- ! Number of lines-------------------------------- Length of each line------------------------------Width of trench----------------------------------- Type of filter material-----------------------'-Depth of filter material-----------------------Total length------•----------------------------------- Seepagge it: Distance to,nearest,well_&?"��✓-------Distance.frgm,foundation._.___x',____.___.Di3ance toDneprest I��e_____--__.--._ 4 ® Number of pits------ ---------- Lining material__ _---Size: Diameter_ -='=--------------- e tn_.__---`-----____-- Cesspool: Distance from nearest well-_.- _______Distance from foundation____ ______________Lining material-------------------------------------- l ❑ Size: Diameter------- -----------------------------Depth----------------=-----------------------------------liquid Capacity---------------------------9als. Privy: Distance from nearest well.______-------------------------------------...._Distance from nearest building----------.________ _____-_. ❑ '----------------- '----------------------------- Distance-to nearest lot line------"°--=-----------_--------------------------------------------- -..----------------- Remodeling and/or repairing (describe):--------------------------------------------- ------ ------------------------••--• --------•---------- ----------------------------------------------------------------------------- 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. (Signed)-__ 1 ------------------------------------------------------------ „r � �?,�,•e.11-�/t� ---- --,----- ------------------------ -------------- ---- -- -----{Owner and/or Contra for {Title} --�`�-•'--`-------------------------------------------- ! =� = tT - (Plot plan, showing size of lot, location of system in re tion to wells, buildings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------- DATE------------------ -------------------- �. NG PERMIT ISSUED-------------------- - -- - - --- -- -- ---------------------'---- DATE -------------------------•------------ REVIEWED $Y------------------------------------- --- ---- - - - - �. ---- -- ---------------------------------------------------- DATE Alterations and/or recommendations:--------- ---- i -- ._ -- -•-----------•--•--------------------------------"- ---- --------------------- --------•---•--------•-----•---------------------. . ` ------------------ -----] ----------- _ ____- ---- __i_ .___ __.___� -_ _- -- _ ________ FINAL INSPECTION -BY: - � 6--”.<-----'�------------------------ - ----- - - = -•.� --"=`-"------- - Datef ------ SAN JOAQUIN LOCAL HEALTH DISTRICT f 30 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California .9-2M , Revises 1.57 VP.CO.