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( . i. APPLICATION FOR SANITATION PERMIT Permit No. _11411_f (Complete in Duplicate) of Date Issued �� --- ------ ------- Application is hereby made to the SanjJoaquin 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. i J08 ADDRESS AND LOCATION - -------- . Owner's Name_______ --- .------�_ � - - - -- - ---------------------------------=-------- ----------------------------------------- Phone------------------------------_------ Address------- - - •�. " " - = -------------------- Contractor's Name---'------- -------- -- • ° Phone-----_--- ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:•�/__ Number of bedroorns J--- Number of baths __ __ Lot size __[�f/ Water Supply: Public system R�OeCommuniiy.system ❑ Private'❑ -Depth to Water Table __lywOlt" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑,, Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: 'Yes ❑ No [� New Construction: Yes ❑ No �"FHA/VA: Yes ❑ No Er-- ( TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool permitted if public sewer is available within 200 feet.) . . /, iepti ink: Distance from nearest well_ Distance from foundation___ Material---------__-_______:____.______---_-________-__. I No. of compartments------------------------ -Size----------------------------•---Liquid depth----------------------- ----Capacity----------------------- Ds� I Fie d: Distance from nearest well-----------------Distance from foundation__------------------Distance to nearest lot line-----_------- ___. Number of lines-----------------------------------Length of each fine------------------------------Width.of trench---------------------------------•- Type of filter material________--------------Depth of filter material-----------------------Total length_______________'__.--------------------- ._ Seepage Pit: Distance to nearesf"vwell' Distance from foun ation____/0____-_ Dis nice to nearest lot line---- ` Number of pits_____________________Lining material_ ize: Diameter___..__-_____.Depth---------- ------------ Cesspool: Distance from nearest well_ '-------Distance from foundation--------------------Lining material____,_,:___________-_-_______________ Q ❑ Size: Diameter Depth ------Liquid Capacity------------------------= -I Privy: Distance from nearest well____- _- g------------------------------------------ ❑ Distance to nearest lot line------------------------------ T Distance from om nearest building --------------------------- Remodeling and/or repairing (describe):---------------------- - = ` i ------'------ ------ - r . ,. -' i 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)9 .. ----------- ------(4w+t8�-andq4wGontractor) By---------------------------------- ------- ---------------------------------------------(Title)----- lel am' - :___._: (Plot plan, showing size of I ocation of system in.relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY ( APPLICATION ACCEPTED BY --------------------------------------------------------------------------------------------- DATE------------- r RI VIEWED BY -------------------------- ---==--- --- - - - ------------ ---------- ---------- DATE---- BUILDING PERMIT fSSUED__.. -----,; -- -------------------------------------------------------- DATE--- -- -- Alterations and/or recommendafions:--------- y -----------------------•------------------------------ ----- - k ----------------- -----------------------------------= ------------ ---- ------------------------------------- --- -- ----- - --- T- _ ; ----- ------------------ --•------ ------ -- -- FINAL INSPECTION BY- _____ ---_ -- ------- ----------------------- Z S Date_ SAN JOAQUIN LOCAL HEALTH DISTRICT - ) 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M Revisea 1-57 F.P.CO.