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APPLICATION FOR SANITATION PERMIT Permit No. ..-9............. (Complete in Duplicate) Date Issued _._. ?s)_ Application is hereby made to'fhe 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 LOCATIO f ____ Owner's Name-------------------- ------ - ---- ------------------ ----/-�- ---------- . Phone- -----.-e------- -----•------------- --j----------Address Contractor's Name----------------------------- '�--=------------- ---.--------------------------------•------------------- ------- Phone------------------.---------. E Installation will serve: 6 Residence ❑ Apartment House ❑ Commercial [] .Trailer Court ❑ Motel [] Other 2' Number of living units: _____-- Number of bedrooms Number of baths Lot size --.___-________________ ____ Water Supply: Public system,-,'E]'1-Community cyst ❑" PrivafeDepth to_Water Table" .rft.-^ ` Character of soil to a�depth of 3"feet:� Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑� Previous Application Maden Yes ❑ No❑ .New Construction: Yes'.❑ No.❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 9 No septic tank or'cesspool permitted if public sewer is available within200 feet.) •�. . .�.�Wim.. � �.....� Septic Tank: Distance fromnearest weft-------------_---Distance from k foundation___________ ______Material__-_ _._____...______------------------------ 0 ooPr - 12e------•'--- -- -----------Liqud depth-_--------'___-°-------t-Capac3ty-------------- ---•-•• - Dis osal Field: D• tacefomnea est welt-------'----._�Dstance from foundation--------------------Distance: to nearest lot line_________________ ❑ Numbe�r'.of. lines----------------------------- - Length of each line------------------------- :--.Width of trench.--------------_---------------. Type of filter material-------------------------Depth of'filfer material------------------------Total length_`---_-_-----------•--••------------•---•- Seepage Pit: �iurtna of,n+ares+ wel --------------------- from foundation.-.....:.__ �_;Dista o nearestlot line_________________ _.Distance f ❑ p' Lining material_--------- Sizer Diameter------------ --.Dpth--------------------------------- r— w. .. / Cesspool: Distancejrom nearest + well�Qu-___-1-.Distance fro m.foundation._�- ° if - Lining material___ �¢rlJm_ _-g_______. Size:'Dia�ter_-- -------------`:Depth-=1/---- -----=--------------------- -------------Liquid Capacity---/40.0------------gals, Privy. __ ------------------❑ Distance from nearest well__ __________________________ DIstance from nearest building ------------------------------------------ 1 Distance to nearest lot ..._.. - _ line R . ._- f -�- ------------- -------------- •------------. ------------- •-•----------f--------------------- ------------- ----- __ ! 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. (5i ned 9 } ------ ------- ------ - (Owner and/or Contractor) 6 • Y•----:� -"--- ----- •;••---------------------- ------------�--------------------------�----------------(Title)----------------------- -------------------------------- - (Plot plan, showing size of lot,'location:of.system in-relation to wells,'buildings,-etc.,-can 6e placed on-reverse side). - r - F R'D PARTMENT USE ONLY APPLICATION ACCEPTED BY--- f ` - ` ---------- DATE-----�'� l ---- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE -._.. BUILDING PERMIT ISSUED----------------=------ ---------------"------ ------------------------------------------•-- DATE. Alterations and/or recommendations --._-- .;- —,__--- --------------------------------••-"--•-••--------------------------:..------------•---•----•--...-•---------•------------------- •------- ------------------• ---•-------•-----------------------•-------------•----------------------------•------------ -------- -----------------------_----------------------------_----------_--------_____________________________________________________________________________________________________-_________._-.____-__.____-___--_______..___--. -----------------------_-------------------------_---_------------------_--------------_ ----- ------------------_----------.-----------_--------- _ ti FINAL INSPECTION BY:---_.�,..-- -- --- --- -------- - --------------------- _Date_ ---------14�lf--------------------------------------- SAN'JOAQUIN LOCAL HEALTH DISTRICT 'In South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street /Stockton, California Lodi, California Manteca, California Tracy, California 9-2m ; Revises 1-57 F.P.Co-