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Permit No. I APPLICATION FOR SANITATION PERMIT l (Completerin,,Duplicate) Date Issued --- 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. ----------------------------------- JOB ADDRESS AND LOCATION.�� Phone-----•------------------------------ ------------- Owner's Name------ -------- - ----- ------------------------- ------------------- ------- - --. -- - - - -- Address--------------------- - h Contractor's Name------- ----- ------- ----- ------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ,9j �' Number of living units: _f.__-- Number of bedrooms __/___ Number of baths J---- Lot size •----------------------------------- _�- __1r�' Water Supply: Public system jr Community system ❑ Private ❑ Depth to Water Table Agp__ ft. Character of soil to a depth of 3 feet: Sand,[-. Gravel,❑_-Sandy,Loam f• Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No b� New Construction:#YesJW -,No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.-- (No septic tank or'cesspool'permitted if p ubrlic sewer is availa6l ewithin d 00 feet.) Septic Tank: Distance from nearest we!{4/_�+`__Distance from foundation___- ---------Material-_ -------- ----- - --------- >fj p� No. of compartments-- ---Size- Li uid de th__..-_ __Capauty__-- ` Disposal Field: Distance from nearest weZ I l 1- ____.Distance from founclation__r�o_--_______-Distance to nearest lot line_ +�________. Number of lines----- ----------------------- Length of each line------b-0-----------------Width of trench._--_---�__r---------.------------ Type of filter materiali'fLOf-----Depth of filter material--_-f-P_i-__________Total length__ _0--------------------------------- Seepage Pit: Distance to nearest well____1_1______________Distance from foundation___-______-._______.Distance to nearest lot line----------------- ❑ Number of pits.................... Lining material-----------------------Size: Diameter-----------------------Depth-------_--__________------------- Cesspool- Distance from nearest wJL1---------------Distance from foundation--------------------Lining material--------- _-_______------_-______. Size: Diameter----------------- -----Depth------------------------------------------- = Liquid Capacity gals. El Privy: Distance from Inearest well_ ------------ -------------------------------- from nearest building-----------------------------------.---.-. ❑ Distance to nearest lot Iine0---------------------- ------------------------------------------ Remodeling and/or repairing (des cribe):________ ----�_. --------------------------------------- -------------------------------•------------.---- ---------------------------------------------------------------------------------•------------------------------------------•---------------------------------------------------------------- ----------------- 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. J (Signed) ' �" _� --- --------------------------------------- Owner and/or Contractor By:.- (Title) ----------------- ---------------- - (Plot plan, showing ize of to , location 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-------•--I-------------------------- - ------------- DATE Alterations and/or recommendations--------- ----------------------------- ----------------------------------------------------------------------------------- FINAL INSPECTION B ---------------- Date__ --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California &S-9-2M Revises 1-57 F.P.CO.