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APPLICATION FOR SANITATION PERMIT Permit No. --- 6 O (Complete in Duplicate) Data Issued Application is hereby made to the San Joaquin Local'Health District for a permit to construct and install the work herein described. inance No. 549. This a icatlori is made in tom liance with County Or �� 1 PP P - tY -i JOB ADDRESS D LOCATIJN N.--- -----�- -- �� ='--- Owner's Name r° ---------- Phone-----•--•--------------------------- -------- -- --- Address------- -ifi' '------ -- ---------�tC^ '--`," - -------------•--------------------------------- --------------------------------------------------------- Contractor's Name-- -------------- --• -- -------------------------------------------L------------------------------------------------------------------ Phone------------------------ Installation will serve: . Residence V Apartment House E] Commercial E] Trailer Court ElMotj.l E] Other Number of livinkg units: --- --_ Number of bedrooms -- .. Number baths _ � ._ ---_ Lot size _ ---&Z.-191-1----------------- Water Supply: Publicr system E] � Community"system ElPrivate` Depth t Water Table----_- ft. +'� {I Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ y' Previous Application Made: Yes ❑ No [� New Construction: Yes RKNo [❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspoolpermitted if public sewer is available within 200 feel.) f Septic ank: Distance from-nearest well��j�_______Dista fro fou �tion_((�------��'° -'Mat ill--_- __-__------ _-_.-- /� No-.of compartments--------_-- Lt--__-'--Sze-- - ------Liquiddepth- -- `-------------Capacity._ -Qi1�.-_ t Dispos i Field: Distance from nearest-well O�istance.from.foundatiodf,�- Distance.to.riearest fot 1'. Number of Fines-__.- -- Length of each line---__-______ E - -' ---- -_----- _ Width of trench---_-_1�. Type of filter materia _ - - ----- Total-length---.-Depth of filter material____,_ ---_---_-_ g -------- ._ - -------- -------- Seepage Pit: Distance to nearest well---------_-------------Distance from foundation--------------------Distance to nearest lot ❑ line_____-_-_- ------__ Number of pits---------------- -----Lining material-----------------------Size: Diameter--__-______�----.Depth----------------------_-____-.-- Lingmateral__Cesspool: Distance from nearest well--._-_-__-__.--Distance from foundation------- - -..---------.---____-_------_-_._- ❑ --------------------------------------Size: DiameterDe th------------------------------- - -- - --- - -------Li 'uid Capacity..acit Y-- ---------------------.gals. Privy: Distance from nearest welt----------------.--------------------------------Distance from nearest building_,___----._----------_-_____-----.-___.-. ❑ Distance to nearest lot line--------------------------------------------=-------------------------- .- -----------------= €= Remodeling and/or repairing (describe):-------- ---------------------------- ---------------••-------------------------------------- ------------ _ i Y ------ - ----------- ---- ------------------------------------=-----------------------------•---------- --------------------------------------------- ft hereb--certify that I have prepared this application and thagt the work will be done in accordant- -__an ------------------ I ui - -- y y . p p pp � with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- Wlvft, �_X/Iaote ''" ------------------------------------------------------------(Owner and/or Contractor) Y••-------------------------------------------------------•------------ ---------------------------------------------•---- ------(Title)-------------------------------- --• ------------------------ (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 APPLICATION ACCEPTED BY--- --------_--- -_-_ - ------------------------- -------------------------------------- DATE-�-------------------------------------------------- REVIEWEDBY---------------------------- -- -------------------------------------:------------------------------------------------- DATE-- BUILDING PERMIT ISSUED--------- - ---------------------------=------------------------------------ DATE---- Alterations and/or recommendations:----------------------------------------------------------------------------------- ---------------• -•------------------------•------- - --------------------------------- ----------------------------------------------------------------- -------------------------------------------------- -----------------• -------------• ------------------•--- ------------------- FINAL INSPECTION BY:-_ r � {' --------------------- - 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 . Revised 1.57 RP�CO. -