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- s APPL r✓'�' �� ATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) , Date Issued -------_............_6. / 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 AN LO ATIC�1--'2 j 6 O� --------------------------------------------------------------------- - - ------ _-_ - ----------- ----------- Pho e Address ass____Name .� _Z-_---1 '� ----- ________________________s________ -------------_-----------------------_---___ __- ------------ _`----------------------•-------- Contractor's Name----------- - ----------- -------------------------------------------------------------------------- ----------- Pho Installation will serve: Reside ce Apartment House ❑ 1Commercial ❑ Trailer Court ❑ Motel ❑ Other 47 Number of livin units:_______ Number of bedrooms _____!'_ Number of baths _____�_ Lot size ___S��_, ___�_� '__ /_______________ 9 Water Supply: Public system ❑ Community system x Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Of Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes) No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if, public se er is available within 200 feet.) Septic Tank: Distance from nearest w� ance fro found�aa n----1Q--------.Ma eri�L-•--- . No. of compartm ----------- ___ e__ _ ._ _ _v.___Liquid depth.... _____Capacity____ s _____ Disposal Field: Distance from Weare t well __ _ nce from foundation-------y��...Distance to neares tofJe___ ____ Number of lines--�___________________ ___Length of each line___YDh/idth of trench__ _ ___.__________________ Type of filter material— T__ _ __ _Depth of filter material____-�_$_rP_____Total length________.71.7________________________ Q Seepage Pit: 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-------------------------.-------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building_________________________________________- r ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Q Remodelingand/or repairing (describe):--------------•------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------•-------------• -----------------------------------------------------------------------------------------_ ------------------------•-•-----------------------•----------•------=-----------------•------------------------------------------•---------------------•---=--•-----•----------------------•--------------------------------- --------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------_----- 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)--- -- -------- - -- -- (Owner and/or Contractor) (Title)---------------------------------------------------------------- By: ,5�_ AA3 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- ------------------------ •--------------------------------------- DATE---------------------------------------------------------- REVIEWED BY ----------- *`-- DATE A BUILDING PERMIT ISSUED------------ --------- DATE---------------------�-`�--`- --- ------------- Alterationsand/or recommendations-------------------------------------------------------------------------------------------------------------------------------•------------------------------ -----------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------•--------------------------------- --------------------------------------------------•-••-------------------------------------------------------------------------------------------------------------------------___-------------------------------------------- ---------------------•--•--------------------•--------•--- -------------------------------------------------------------------------------------------------____----------------------------------------------------------- ---------- ----- 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.