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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct.enS3 st all?he work herein described. This application is made in compliance with County Ordinance No. 549. •� 12 JOB ADDRESS ANP LOCATION"_. ' - �, r� Phone.............-" .... . Owners Name..- ---- ----•.. ------yyam�---''-- -----------.----- ----•------- Address------------------ �•r----- - -----... .... Contractor's Name----- --- .. Phone. Installation will serve: Residence . Apartment House ❑ Commercial ❑ Trailer Court91 Mofii ❑ Other ❑ �-, Number of bedrooms,. Number of baths ._�_._ Lot size _______� -----------�-- -------------.. r-• Number of living units: .._.. -" �-O� "" Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table b..Q- Character of soil to a depth of 3 feet: Sand ❑ Gravel Y Sandy Loa;❑ Clay Loam ❑ Clay D Adobe ❑ Hardpan ❑ Previous Application Made: Yes El No New Construction: Yes x No ❑ FHA/VA: Yes C, No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli_. �..(." DistaJJ�c fr m foulaaon }-Z!. ._.Mater' �. -� X J J--� No. of compartments.._.__.---.----. .•Size_62. - ---X..«:__Liquid depth..... .. ly acity.... ,- - Disposal Disposal Field: Distance from nearest well------------ ..._Distance from foundation__..-------.--------Distance to nearest lot line--------- Q ❑�-- Num:)er of lines------"---------- ---•--Length of each line-- ----------------- ---------Width of trench...--------------.- j' �fype o� filter material............... . .....Depth of filter material.__.......____.___... Total length__._._.___..._..______...---------------- IV) Seepage P;R: 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_...-_--_._---- ..____. _.__--_ Size: Diameter---- ---- Depih---------------------------------------------------Liquid Capacity... . ---------------- 9a1I n Privy: Distance :-om nearest well------------- .Distance from nearest building...... . ............--------.....___-, ❑ Distance to nearest lot line-------------- -- ......••..•- ---------------. -------------•---- -------------------------- ------ r - Remodelin nd or re eirin scribe :.__ .df__ ---- 9 P �- _ - - " I hereby certif that I have prepare this application and that the work will be done in a ordance with San Joaquin County ordinances, tAte laws, and rules and regulations of the San Joaquin Local Health District. `l- V. (Signed)...... ,�,.t_ --- ------ ------------- ------------- (Owner and/or Contractor) - ;. Title - -- (Plot plan, showing sae of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----------------------...---•• ------- BATE. BY... _,... .._....... DATE--•---- ? �• --��' 7 - REVIEWED , BUILDING PERMIT ISSUED-------------- •---------- _ ..--- — DATE._. ........ Alterations and/or recommendations:............................... ---••---------------------•--•----•- ---•----------------------••--------•-----•--•-------- -•-----------------------------•-••-----------......--------••••-•.....----••----....._......._._------.-------- --------------------------------I................................................... ----------------------------------------------- -"---•----•--•...........................-•--••--..................-------------- -- ------------------------------ .................................. ........................ -•------- ................................................_.....--•------------..--..-..__... ------------------ FINAL INSPECTION BY:----.. - ---------------------- � 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--9-2M Revisea 1.57 F.P CO.