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APPLICATION FOR SANITATION PERMIT Permit No. ..... � -. (Complete in Duplicate) . This Permit Ex ices I Year From Date Issued Date Issued ..__//Z " Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the work herein describe ., This application is made in compliance County Ordinance No. 549. -�.. - --------------------------------- ---------- Owner's JOB ADDRESS—AN D°LOCATIONy Name_� "-----,��_"__•--•-�." , . �. Phone- ---- - Address '_." `. ----------------- ; ontractor s Name----- - -- rc_ ------------------------------------------------ -------------------••---------- ------------ Phone----- ..... Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _--___ Number of bedrooms a----- Number of baths 1.1�_ Lot size ___�_A ❑ Water Supply: Public s s+em <...................................... y ❑ Community system ❑ Private ® Depth to Water.Table -------- ft. Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay El Adobe E] Hardpan [] w Previous Application Made: Yes El No EDNew Construction: Yes 0 No ElFHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearest well-_/,_ __ :Distance from foundation_ - - f - = No. of coin artments_ t` t ------- p from Liquid depth'�1� ---------Capacity�,�/�---------- Disposal Field: Distance from nearest well-1,-Xl"- -Distance from foundation_,-. - ___ ____________Distance to nearest lot Number of lines__3_____________ s -----------------y� Length of each line-----� --------------------Width of #ranch-- �'-`�--.---------- --------- Type of filter materiae-'! '__Depth of filter material---lt-K-----------Total length---�'�d" _ - ---------------------- 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----------------------------------------------------Li Liquid Capacity q ----------------------------gals. El Privy: Distance-from nearest well _ _Distance from nearest buildin ; Distance to nearest'lot line----------------"-"-- " g -""""---- -------- `---------------------------------------------- - - --------------------------------------- - Remodeling and/or repairing {describe)_________________________ t -------------------- ----•--------------------------------------------------. -------------------------------------------------------- - --------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty laws, an ordinances, State d rules and regulations of the San Joaquin Local Health District. d]-- (Signe _ ____ __ ______ " . - -- -- - ------- -- - T ------------------[Owner and/or Contractor)- C - - -------------------------------------------(Title)--------------------. -- ---- . _ ---- (Plot pian, 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__ _ ,r,, - - �- � ------------------ DATE.- REVIEWED BY------ ------------------------------------------- .. - ----------------------- DATE ------------------------------ ILDING PERMIT ISSUED-_______-••--- ------------------------- ------- DATE------------- ----------------------------------------------- ------------- A aerations and/or recommendations: ----------------------- FINAL INSPECTION BY:._ F } --------------- Date- ----------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street y 814 North "C" Street Stockton, California Lod;, California Manteca, California Tracy, California ES-9-2M Revised 8-'S9 F.P.Co.