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/I-/1� p M A t(,f G APPLICXTION�F6; SANITATION PERMIT Permit No. .....----_ (Complete in Duplicate) s y 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 LC TION- p - ----- .__ - Owner's Name X ------ Phone--j ... Address----.......... ------------------------------ --------------------------- Contractor's Name--------•- Phone i Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms _ -_ Number of baths __/_-- Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E!r--Tlardpan ❑ Previous Application Made: Yes [❑ No 2?" New Construction: Yes P2014o ❑ FHA/VA: Yes 24---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank br'cesspool permitted if public sewer is available within 200 feet.) ® �p Septic Tank: Distance from nearest well_'71.. �_Distanc from foundation___ D--r--.Mater}al------- L� No. of compartments--_-l-'___.---___-.--Size_ _-X__q,0-------Liquid depth__--- - _-Capa --- p tY Disposal Field: Distance from nearest well_.,— ,7+�°/bistance from foundation----/� Distance to nearest lot line---��-_ Number of lines___---__- --------------,--_/-Length of each line--- _ r' �-�------�� Width of trench-------- Type ------------ --- of filter materia \ I�-�- -- -----Depth of filter material---f�-----------Total length---_--��_�_-''-------- ------------ Seepage Pit: Distance to nearest well__� r�� `� ° Distance"omundation-- is �P�e to nearest lot line-----------------Number of pits.-___/___------___Lining material --------Size: Diameter_rJ --- r -- ---.Depth --1��-� --------------- Cesspool: Distance from nearest well----- ---------Distance from foundation.__-----------------Lining material----------__-_----- ,. ❑ Size: Diameter------------------------------------ Depth----------------------------------------------------Liquid Capacity- -------gals. Privy: Distance from nearest well-_-------------_----------_--_--_-_ ---._Distance from nearest building----.-- f ❑ Distance to nearest lot line----------------------------------------- _- ---------------------- ---- -------------------------- Remodeling .and/or repairing (describe)-------------"a ------------------------•---------------------- / ordinances, State laws, and ule and regulations ons of----------------------- ca - --a --ha h -- or will------------------------ e - - in ac - c ----------------------------------------- ISan --------------------------------- - ---------- -------------- • hereb car+if that I have application and that the work will be done in accordance with San Joaquin County g f +he San Joaquin Local Health District. (Signed)------- ------ -- " f/C --------------------------------- Title Contractor) By:---------------- (Plot plan, showing size of lot, loc A�osstem in relation to well;, buildings, etc., can be placed on raver side]. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------ - ----------- DATE--_--------------- -- -------------------•- IEWED BY DATE--------- ' BUILDINGPERMIT ISSUED--------------------------- � -- ------------------------------- DATE __1------------ .........--- - REV - ------------------- - - --------------------- Alterations and/or recommendations:----.----------------- --------------------------•----_ ••- ___ - � �=. � 1 -------------------------------------------------------------- -�f /� o.` .Cc�a�.La..a� -------------- -- - J 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 i Lodi, California Manteca, California Tracy, California ES-9-2M Revised ;-57 F.P.CO..