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M� APPLICATION"FOR SANITATION tPERMIT Permit N ....... (Comp[ete in Duplicate) Date Issued __-;-------l Application is hereby-�i ade to the SanlJoaquin Local Health District for a perms to Spnstruct and in fall the work herein des6ribed. This application i made in compliance with County Ordinance No. 549. . ' � ' ' ' l/.�J �� lQf�G�f JOB ADDRESS At;Dl . LOCAT-ION t � � --Owner's Name .. ------------r---) -------- � P hone------------- ------------------ ------ Address Contractor's Name ------ ---------•--- Phone.........•-----•------------------- ' 1 ----•--- e Installation will sere: Residence [v"Apartmen t House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other ❑ t t r Number of living units: __!_____ Number of bedrooms _. __ Number o •baths ___r___ Lot size�___;(--�__n_�____�_____________________________ Water Supply: P blit system-E-] Community system E] Private 0 .Depth to Water Table ____ ____ ft. Character of soil to},a depth of 3 feet: Sand El Graves ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe [Hardpan E]Previous Application Made: Yes ❑ No 'New Construction: Yes.L� No ElFHA/VA: Yes El No L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) S pti Tank:_ Distance from nearest well-----------------Distance from fossndatjon .� MateriaL_____________________________________________ • P ------------- `Siz ----------.._------ou'�at o �pP -ista-jt. . --'Capacity-- ------------9;--- Hi -. L,_ _ istance l No. of compartments n -.11-iquid de h___.__ Disposa Fiel D stance..,frorm.,nearest.wel- __(,l -rl,�e -from„f ce to nearest for linea___ Number of lines ________ _ ngth of eachlir r*' _r _ Width`•of trench_.____._ _ _. _ ____ Type 'ftf? �" ep m-a,. � �a ----- T e of filter materia ! e th of filter matarial___------------ Total length________________..__ r I See a Pit: Distance to nearest' ell___ _______Distan� nfrom•foundation__&p_ Dlstan e# ocnearest-lot line____________ e ( Number of pits--------I--------_ Lining material_ ^" Size:'Diameter------�__6_��__Depth....... � �__________- Cesspool: Distance from nearest well------------------Distance from foundation-----.--------------Lining.*materia!____.._____________:.____________- ❑ Size: Diameter--------------------------- ------Depth------------------------------ ---------------------LiquidlCapacity------------ -------gals. r. Privy: Distance from nearest well-----------------------.-------------------------Distance from nearest building_____________-_----_-_'....-.___.______- ❑ Distance to nearest lot-line----------=-------------------------------------------------------.------------------------- ------------------------------------------------ Remodelingand/or repairing (describe)--------------------------=------------------•------•-----------------------------------------•- ----------------•--•--------------=--------•-------- ------------••-----•-------------------------------- ------------------------•------------------------------•---•----------------------------------------- •----------•------ ---- -- I hereby certify that I have prepared this application and that 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. --------------------------------------- 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 APPLICATION ACCEPTED BY_ DATE-------------------------------------------------- ------ ----------- REVIEWED BY.-----•--------------------- � ---------------- ------ ---------------------------------------- DATE---'�µ- -------•------------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------=-------------------------------------------------------. DATE------Z:,�-------------------------------------------------- Alterationsand/or recomme ations---------=------ ---------------------------------- ---------------•--------------------•-- ------------------------------------------------------- _ 26:.s -------- l` 'tp /- '1. - CR ---------- — -------- 44C -��--- - � ---------------------------------- FINAL INSPECTION-•BY: -------------= - ----------- Date----- ----E,--- "= SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M , Revised 1.57 F.P.CO.