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APPLICATION .EOR_SANITATION PERMIT Permit63 [Complete in Duplicate) Date Issued _T/�.��-•• Application is hereby made to the San Joaquin Local Health Dist ricf 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 LOC TION' --------------------------------- _ 1 ,�> Owner's Name-------- — -------------•------------------------------------ ------- :. .. ---------- Phone.-.----------------------------- Address__.--_____.. - - -------------- Contractor's Name--------------- ---------- --- 1 Installation will serve: ^ Residence II --------- ---- 'PhoneOfa & parfinent House I] 'Commercial ❑ Trailer:Court ❑ Motel I Other ❑ Number of living units: - Number_of bedrooms _ _ Number of baths __ __ Lot size +.S Q 1. T F ________________________________ Water Supply: Public system �Communrtyi system,[] Private .❑ -Depth to Water Table .Sd ft. -�- Character of soil to a depth of,3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B-11ardpan ❑ Previous Application Made: Yes El ..-No E�-_�New Construction:_Yes,❑ No R�'FHA/VA: Yes ❑ No Er�_ TYPE:OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ticDistance o twell- -- tance from foundation Material -- ---------------------------------- No. of tompartments - -- ------- Size ---Liquid depth--------------, r --- --------Capacity---------------------- 11spo al F Id: Distance from nearest well_--_¢-----------Distance from foundation--------------- _4 _-Disfance to nearest lot line Number of linos-----------------------------------Length of each line------------------------_-__- Width of french----------------•---- Type of filter material-------:---- ------------Depth of filter material-------------------�--Total length-_------------------_- ------------------- Seepage Pit: Distance to nearest well"_Disfan m fo ndafion___ f 1__ ____.Qi tance��to nearest lot line d-----__ Number of pits----- -------- ---Linin material -- �, g Size: Diameter Depth-- - -------------------- Cesspool: Distance--from nearest well-------- ---------Distance from foundation---------------------Lining materia)_--_______----- �,' ❑ Size: Dimeter -Y Depth 1,-. e---- _ --------------------------------------------Liquid Capacity------------•---------------gals.Privy Distance from nearest well______--__""_____________ _____________________Distance from nearest --_ buding__----_______-------------❑ Distance to nearest lot line ---- ------ -------- --- --------- ------ -- "U Remodeling and/or repairing (desc!ibe)--------------------_----_ -----------------•---------------------- --------- ------------- ----------------------•--------------••--------------------- ------------------ a I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, Stat Ws, and rules and re tions of the San Joaquin Local Health District. (Signed)------ --- - - ---------------------- " "- Owner and/or Contractor) By: -=••----------------- � e (Title)-- (Plot plan, showing size of lot, location of sysfem in relation to wells, buil& gs, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------------------------------------_ __________________ DATE_. -------•-- ------------•-------------------- REVIEWED BY------------------------------------ .� •---------------------------------------------------------------- DATE-------- -• ' BUILDING PERMIT ISSUED-----�----- 1----- ------------ DATE------------ - Alterations and/or recommendations:________.____-- _ ---------- ------------ ---'� =� -------- -------------- -------- ---- .. ------ ;N ---- - • ------------- ------------------------------------ - ---------- - FINAL INSPECTION BY:_- -:- ----e ----------------------- Date --' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfroat 814 North "C" Street ' Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-s7 F.P,co.