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APPLICATION FOR-SANITATION PERMIT Permit No. ._..iMv_____ { / (Complete in Duplicate) r 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 Ordinance No. 549, JOB ADDRESS AN LOCATION____-_)---- ---- --"'- --- -- -------°'.1___.___ - -- i Owner's Name--- ,�..� .e7. _ - _ - .�... .•- - ------r------------ - ------------------- Phone____:777= Address Address-------- 0�-- =------------------------ Contractor's Name ------------------------------ -------------•----------------------------- Ph ne Installation will serve: Residence ❑ : Apartment House ❑ Commercia I ❑ Trailer Court A Motel Number of living units: _ _ Number of bedrooms _ Number of baths I-__ Lot size --------- Q Water Supply: Public-system E] Community system E3 Private ❑ Depth to Water Tabl _ ft: Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ - No [] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dis#ante from nearest well____ ________'Distance from foundation__-l_ ______.Material__-_ Ar '_ --- Liquid depth------�---------------C No. of compartments---- ----- ---_- Disposal Field: Distance from nearest well--..._'Distance from foundation_____a_ ------ Distance to nearest lot li�p____,_�k.,_-_____ Number of iines__t_0__-_ _ _ __ Length of each line___7-6 ---------*J,0'/idth of trench__________ --- Type of filter matenaL._ _ _ __Depth of filter materia!_f. ____.____-____._Total length---;2_j_0____________________,____- Seepage Pit: Distance to nearest well_:_:__ ._------------D;stance from foundation----------------------Distance to nearest lot line__._______-_-___ ❑ Number of pits--:I----------- ----Linirg material_-----------------------Size: Diameter---_________. D 9 epth ------------ Cesspool: Distance from nearest , rest wall___' _ ______Distance from foundation--------------- Linin material------------------------------------ ❑ Size: Diameter-_.-Il------------ ----------------.-----Depth----------------------------------------------------Liquid Capacity- - -----------------------.gals. Privy: Distance from nearest well_______ _______ __-----------------__--------'----.-Distance from nearest building.----. ❑ Distance to nearest lot'line _._ -.-----'------------ ------------------------------------ --------------------------------------------------- --------- Remodeling and/or repairing {describe)---------- ------------------------------'- ---- --- I. -----•------•----------------•-------- -------•--------- --=-------- --------------•-------------•--------------------•----------- --------------------------------•------- --------------------------.--_------------------•-- i t ------ ---••-- -------•-•----------------------------------------------- -----------------------•----------------------------------- I hereby certify that I have prepared this application and fhat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health 'District:66 + Y 1 (Signed) :. F-' -- - (Owner and/or Contractor) BY: =------------------------ -------------•--------:------------------------------------------------------------(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 --------------------------- ` i APPLICATION ACCEPTED BY ;` =-------------------------------------------------------------------------------- DATE--------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------- -------- DATE------ • ------------•----•------- BUILDING PERMIT ISSUED---------------- -----------------------------------------------------------_------------------------ DATE.--------- = Alterations and/o ret mmendati ns:.�_________________________ ___________ -- ----------------------------------- r �-- - --- - -------- ------- - ----------------- ------- � _ = - -- /x - - 2 19y FINAL INSPECTION BY: W_ _7'_( Date :- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 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.