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APPLICATION FOR SANITATION PERMIT Permit No. 3 (Complete in Duplicate) Date Issued -- 1s is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. .549.. - CA C JOB ADDRESS AND CAT ON-----ffA ------------------ Phone------------------------------------ - U .... 1-r-0111--------------------------------------------- -------------------- owner's Name---------- ------- Address---------------------------- —------------------------------------------------------•------------------------------------------------------------------------------------------------------- Phone.-------•------------------------ --------- Contractor's Name- will serve: Res.idence ,Apartment House El Commercial E] Trailer Court 0 Motel 0, Other E] Number of living units: _-)---- Number of bedrooms -,P-- Number of baths j--- Lot size -d---------------------- Water Supply: Public system ED Community system El Privafejg�Pepfl-i to Water Table .-d ff. Character of soil to a depth of 3 feet: Sand F-1 Gravel D Sandy Loam 54 Clay Loam El Clay F] Adobe E] Hardpan ❑ Previous Application Made: Yes El No%jj New Construction: Yes No El FHA/VA: Yes E] Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ion ---.Material------------------------------------- ------- septic Tank: Distance from nearest well--15-0-_ -"_ Distant from foundat 9------------- '§ ----------Capacity No. of compartments, ---------------Size----Size---- _-Liquid dep.fh-------- ----------Distance to nearest lot line----1$7 Disposal Field: Distance from nearest well-----_-Distance Distance from foundaf ----------�Wiclth of trench -Y/------------------- Number of lines--- t2 -------Length of each line"-____ 1 0 ` .1 P, ------Total lano-----1-0--6-------- ----------------- e*ri-a Depth of filter material-- _p------- Type of filter material____----- Seepage Pit: Distance to nearest well------------- --------Distance from foundation--------------------Distance to nearest lot line_________________ Number of pits --- -- --- F1 pits----------------------Lining Lining material-----------------------Size: Diameter. f=- --------------------------------- Aw—� Lining material___._ ------------------------- Cesspool: Distance from nearest well--------------.--Distance from foundation---:------------ --- 4 W ElSize: Diameter------------------------- - ----------Depth------------i----------------------------------------Liquid Capacily-,_-----------------------gals- ,4 ---------------- --- Privy: Distance from nearest well---_ .:a------------- Distance from nearest building_____________________ - ❑ Distance to nearest lot line---------- ------------------------- ------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------- ------I-------------------------------------- ----------------I------------------------------------------------- --------------------------------------------b------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------•1-----•----------------- ------------------------------------ ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 rull s and irelations a the San Joaquin Local Health District. -- ---------------------- ----------------- ---------------____---(Owner and/or Contractor) (Signed)----i��_ -------- - - ---- ----------------- -L - By:----------------------------- ------------------------------------------------------------------------------------------------------- (Title)------------------------- --------------------- ---------------- (Plot plan, showing size of lot, location of system in relafion.+o wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------- DATE---- -------------------- ) REVIEWEDBY----------------------------------------- DNTE---- -------------------- BUILDING PERMIT ISSUED--------------- ---------- ------ ----------- -------------------------------------------- DATE---------------------------------- -------------------------- A erations and/or recommendations -------------------------------- -------------------1----------------------------------- ------------- -- -- ------0_,�---------------------- 411 ----- -------------------I------------- --- - ------------ WX-El------------ ----------------------------- ------------- -------------------- ------ - -- ------------------------------------------------------------- 5; _QA . .....2Lt-,�1------ ----------- -----------5VI- --------- --- ------161"Llt,"------ -.-,A. .......... ---------------------------------------------- ------------------------------------------kLq L---------st:�A�_ FINALINSPECTION 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-