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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit tQ constr•ct�and install the wo'r.k herein described. This application is made in compliance_with/Count rdinance No. 549. x/ ( JO DD 1 �+ r _=: .c'_ _------------r --------:- ------ ----- ------------- Phone-----------_-- Owner's Name_.___�__._ _-._ ________ Address----------- ' sd:.-... ' � ---------•--------------------------------- � Contractor's Name--- #---- --- ----------•---` -- -- ----------------------- Phone----------------------------------- d Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Ot,h�r Number of _living units: _�.--__ Number of bedrooms ___ NumVDepfh f baths _�_____ Lot size _ --------- ---- _: Water Supply;. Public system❑""Community system ❑--Private to Water Table ___x" ft.; _T-- ' Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam El Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made: Yes F] No New Construction: Yes EKNo ❑ FHA/VA:Yes ❑ No ❑ f _ TYPE OF INSTALLATION AND SFECIFICATIO_ NS: . No septic tank or'cesspool permitted if-pub c sewer is available within 200 feetr�� _ MaterVal No. of compartme est well______ __Distance fro foup¢ation___ _._ ,-(.�! ------- p -_ _. X- X Liquid e th.-- #n-------------- Se tic ink: Distance from near � _ ,Size+ .. __�__k__ __________ q � p � Capacity..4-_:�_��._._r p nts_ Dispo�s/al Field: Distance from nearest well `D stance from,foundation_ 1 _ istance to nearest lot line ----- _7 [�J Number of lines--------'�� _ '� 9 --0---- tf---- Width of trench ?`"-�--0-----------" -- -- ----_--- --------- - d Type of filter materia __ 't_ __L epth of filter material_ -___E'4.-'- Total length____________ _e��'._ - Seep g Humber of its.___.__.-8_,_.___:.�Linin material-'___________________Size: Diamete Distance to nearest lot line_____._._________ ❑a a Pit: �." Distance .to P eares�Vw�I�____.---- --�-g Distance from foundation-------------;r V-------------------- ---- - ----=-- - -Depth-------.'---------..--'----------- Cesspool: Distance from nearesf.well____'-------------Distance from foundation-------------------:Lining material-------------------------------------- ❑ Size: Diameter k "° Depth - -= Liquid CapacitY ------------------gals, Privy: Distance from nearest well___'-----------------------------------------_'----Distance from nearest ❑ ^ . v V f building,___________-_-_______.__ -Distance to nearest lot-line _ : :_-:-----------'=-- ____________________y,._____--_____.___..____.- Remode4*0 andl/or repairing (descri � `` R l ----------- -•--------- -------------`-------------------•------•----------------- ---------------------- ------------ i -�.---1--------'----- ----ti-- --- ---------- ------ "- ------------------------------------------•-------------•---------------------------------------- ��rrl� --� ---- --- ------------------------- i W I -------------------'-•-•------'_ --------- •--- -------•----- II . . P A. -------------------------------------------------------- ------ ----g---•----------------------------------------------------------.-----------------.--------------------------•--------------------------------------- I hereby certify that l have prepared this application and that the work will be done-in accordance with San Joaquin-County ordinances, i he San sloa uin Local Health District, State laws, and rules and-re regulations of t �-�A=.r -- - "fi r - .,-------------- ---- ----------------------------- (Owner and/or Contractor (Signed) r Y / ) Plot Ian, showing size of lot, location of system in to ' r. 3 By:------------------------------- --------- ------ --------- ---=----------= -----------------------•-(Title)-------•--•----------------•-------------- -- ------------ - - ( p g y wells, buildings, etc.; can-6e placed on reverse side). � I FOR DEPARTMENT USE ONLY = DATE = APPLICATION ACCEPTED BY }__._ ___ _-- REVIEWEDBY------------'=---- ---- ----- --- ----- -- ----- - ---V------------------ ------------------------.DATE &----------------------------------------------------- BUILDING PERMIT ISSUED------------------+ --_----_--- -------------------_- -DATE----_�� __ - - - Alterations and/or recommendations:---=--------------- -------- ----- ---------,______------------------------------------- -------- -------------.._.-- ---------------•---•-----------•--------------------•------------------------------- -•- ---------- ------------------------ ------------- -----------------------------------------• -----•----•--•-••---------•-------••-- --------------------------- ------------------_____-------_---------------------------------------------------------------------------------------____________---------------------------------------------------------------------------.---------------- ----------------------------------------------------------- FINAL INSPECTION ------------------------ Date---op. ------------------------------------------------------- SAN -------__SAN JOAQUIN LOCAL HEALTH DISTRICT . 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P,CO.