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C7.1s11 ✓ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) — Date Issued119___ Application is hereby made to the San Joaquin Local Health District for a perm-+T to construct and ins all the work herein described. This applica#iori is made in compliance with County Ordinance No. 49, JOB ADDRESS AND / + - - - ----------- -- -- �' . -------- U` Owner's Name------- �� ---------- ------------------ -------------- ------------------ Phone------------------------------------ Address ----•------------------------------ d � --• �----•-. ------------------•--•-------------------•--------------•-------•--------------------.... Address----------------•------••------._....- - --- - •- ----- Contractor's Name____________ ___ _ Phone J_ _ . f6 Installa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer -Court ❑ Motel ❑ Other ❑ Number of living units: ---/" Number of bedrooms `_Number of baths _/___ Lot size __Xl4t_fD_---___________________ Water Supply: Public system ❑ Community system ❑I Private ❑ Depth to Water Table -_`17 ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Lo;/No Clay Loam ❑ Clay ❑ Adobe �Fdpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ FHA/VA: Yes ❑ No + TYPE OF INSTALLATION AND SPECIFICATIONS: .` (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) i � Septic T Distance from nearest wEll_:__ ___.__Distance from foundation____�L'-------Mat rial____(,`.0—_s jL_ No. of compartments--------- size__,5-6_Xf��-_Liquid depth------ �/� �----Capacity Disposal 'eld: Distance from nearest wel}j1L7jF '_.Distance from foundation--/'o____ Distance to nearest lot line_v�__ _ ________-- Number of lines_____ __ _____ _____Length of each line....... FQ Width of trench.__ Type of filter material._._}�¢�____________Depth of filter material_____`r_ _____Total length_________- _________________________ Seepag it: Distance to nearest well--/----______Distance from foundation__��_--...Distance to nearest lot line-_,6__�._- Number \ Numberof pits.........1----------Lining material__- _Size: Diameter____e ------.Depth---a -4 ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------------Lining material-------------------------------------- U.,I ❑ Size: Diameter----------------------- --------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_--____-_---________________________..._. ❑ Distance to nearest lot line-------------------------- -- ---------------------- Remodeling --------------------Remodeling and/or repairing (describe)= y� � -----------------------•---------------------•------•-------•-----•-•----•-••-----------------------•---•---•------------------•-- ---•----•----- --------- ----- - --------- ------------------------------------------------------------ ---------------------=---------•---------------•--•-------------------------------- 3 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby `certify that I have prepared this ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, a les nd regulati o he Joa uin Local Health District. (Signed)------------------ --- ---- -- ----- -- ------------------- -- --- -- -- --- ------ ------- ---- ------------------------------------------- Owner and/ ontrac#or) -- ---------------------- (Plot plan, showing size t, locati of system in relation to wells, buildin c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•-------------------- ------------------- ---------------------------------------------- DATE-------------- •-------------------------- --------------- ----------------------------- DATE- ------------------ --------- REVIEWED--B--Y-----I----------------- ------------------------------------------------------ - ---- -- ------ ----------------= ---- ---�--- - - BUILDING PERMIT ISSUED-------------- ------ - ---------------------------------------- DATE Alterations and/or recommendations______________ _ __ __ _ __ __ ________________ ------------- ----------------------------- -------- -------------------------- . --------- --..... -•-- - ------------------------------------------•------------------------------- - --- -- --------- -------------------------------- -------- -------------------------- ------------------------•---•--------------- ------------ •------------------------.--.----- ---------------- ---- --- -------------- ------------ ----------------------------------- --------------------------------- FINAL INSPECTION BY--------- ----- - -------- - ---------- - bate------7------------------------ ------------------------ -- -- SAN JOAQUIN LOCAL HE H DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revises 1.57 F.P.CO.