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APPLICATION,. FOR SANITATION PERMIT Permit No. _s (Complete in Duplicate) 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 O dinance�No. 549. JOB ADDRESS AND OCATION2.....631---= ------•---------------- ----------- --- . Owner's Name...... _._ a YL_ Phone--'7777�_�. d .0 --------- ---------- r - Address =..-_.... =-•-----------=----------------•-•--------------------------------------•----------- •--.-=--------••-------.. ...... Contractor's Name------__4t - - --•-•------------------------------------------------------------------------ ------ Phone-----•---------------------------- Installation will serve: Residence Apartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other [� Number of living units: ___.____ Nurnber of bedrooms __ ____ Nu'mber of baths __�___ Lot size _____rel_ ____ _________�______�____-- -__ r y Water Supply:' Public:system'&CornmLnity system ❑ Private ❑ Depth to Water Table _'TTf Character of soil to a Idepfh of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ t Previouss Application Made:,Yes''K No ❑. New Construction: Ye:A No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION �ANDISP!_CIFICATIONS: (No septic tank or'cees pool perimifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr well_____- ___Distance from foundation___-__/10_____.Material_--�' '�°�---.--_ _-----. No. of compartm ,ents_ ._-_._----_.__Size___ ----- depth------ ---------Capacity----C---- _. Disposal Field: Distance from nearest well_:_.-�•--c-- Distance from fou clation_c 0----__.__Distance to.n'earest lot line__.__. J Number of lines___- Length of each line__ : - -( __.____.__Width of Type of filter material__=` -_ .__. =_Depth of filter material /_2r_�__.-_Total Rlength___________ --------- ---------- Seepage- - _. Seepage Pit:` "bistance to nearest well_`______ =Distance from --foundation-------------------_Distance to nearest lot hire---------------- ❑ Number of pits.-- --,Lining material---::--Lt -__------Size: Diamefer------------------------Depth--------'-'--------------------- Cesspool: Distance from nearest well-----------------Distance from foundatiori--------------------Lining, material__.___-_..______-----_--.__.___._.._.. ❑ Size: Diameter_---__`..------------•----------------De Depth ---`------- ------- ---------- Liquid Capacity als. p -------- q p y----------------------------g Privy: .—Distance from nearest well-------------------------------------------------Distance from nearest buildin e' f ❑ est lot line _ _ 9.01 ; Remodeling k,., and/or r4pairing (describe):i o near I p 9 ibel ------------ ----------------•-------------------=•------------------------------------------------------------------------------ --------------------- -----r----------------- _ z1. i ------------------------------------ _ - --:-•-----------------•----------•---------------------------•--------=--------------------_----•------------------------•-------------------------••----------- hereb �E--- hat,l have prevI----------- ------------------'---------------------------------- -----•----•------------------------------------•----------- ------------------------------ y pared this•applicafion and that the work will be done in accordance with San Joaquin County ordinances;Sta I s.' rules and gulations of the San Joaquin Local Health District. (Signed)----- ------------------------ (Owner and/or Contractor) ' - . ---------------------------------------------------- - -------- -- Title ---•--------� (---------------------------=--- -------- (Plot plan, showing size of lot,,loca+ion of system in relation Jo wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - --- ------ - -- --------------------------------------------------- DATE--------••------. ------- ------------ REVIEWEDBY--------------—A---------------- --- - - --- --------------------------------------- DATE----------- - �' -- w s ----------- BUILDING PERMIT ISSUED - Z = DATE ----------------- Alterations and/or recommendations:_______.._ -- -- - - ----------- ------------ -------------------- ------------•---------------------------••------...------ -_.._ w -. _--------------------- ------------------------------------ I - = --------------------------------------- -----------•---------------------------------------- ------•----------------------------------------------------------------------•-------------------------------- 9 L 4 - FINAL INSPECTION-BY:.- ----- -- -- -- - ---------------- -Date _ �•. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street -t— 132 Sycamore Sfreet *. 814 North "C" Street . Stockton, California Lodi, California 1-\ Manteca,"California, Tracy, California E5---9-2M Revised 1.57 FT.CO.