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APPLICATION FOR SANITATION PERMIT Permit No. ..�_{..t°.� Q (Complete in Duplicate) Date Issued r------------- Application ----: vApplication 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 AND LOCATION.___ Owner's Name------- -t --------- -`1? 11.------------------- ------ Phone----------------- . ----------------- Address--------------ih!. _ -------- - - -1--------------------------------------- ----------- ---------------------------------------- Contractor's Name.. b - ��e /.� r �' Phonon ll1 � Installation will serve: Residence ` Apartment House E] Commercial ❑ Trailer Court E] Motel Other ❑ Number of living units: Number of bedrooms -/_--.- Number of baths . _._._ Lot size ...._.. _...� Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table 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.) Se tic k: Distance from nearest we€f-----------------Distance from foundation-------------------Material_..-___......_____..-_-__..___.__....___._..... i� � No. of compartments---------- ---------------Size------••------------------------Liquid depth--------------------------Capacity r ---- is os ,,¢'T f Distance from nearest we€!_________Distance from foundation---fin_._....--.Distance to nearest lot line. (p /f" lam,f„� Number of linesline f�`-�' ___Length of each ....._ _ p__ r_____-Width of #Tench-__ �, ; Z" Type of filter material___ _e_-Depth of.filter material ._.._/r-------_'_Total seepa Pit: Distance to nearest well----f .O__ foundation__.-__... -------.Distan.t_ to nearest lot li --f Number of pits--------f----_ Lining material- �� Size: Diameter __ r___Dept .. . ------ __-------------- CeDistance from nearest well___-.------_'__.Distance from foundation----------------.-- Lining material-------------------- . ❑ t Size:.Diameter-------=-------------------- --- --Depth----- ---`- ------------------------------.Liquid.Capacity.---------------------------gals. Privy: Distance from nearest yell-------------------------------------------------Distance from nearest building __ ❑ Distance to nearest lot line.-------- Remodeling and or repairing (describe :__.. __.___ ---------- o- _ f� -c� --------------------- - ---------•- - -- - - - - ------------ - ------- - - - -- -- - --- ------------" --- ------------------ --------- - ------------------------------------------------------•-------------------------------------- ----------=--------------------•-------------------------•----------•--------------------------------------- I hereby certify tha have repay 1s plication and that the work will be done in accordance with San Joaquin County ordinances, State laws r s and reg 'ons of the San Joaquin-Local Health District. {Signed? • - _ / t t Owner and/or Can rac o ---------_(Tifle)-- _ By:---------- -------------------•-------------------------- p - (Piot plan, showing size of lot, location of system i relation to wells, buil 1 gs, etc., can be laced on reverse side). \` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED DATE �I = � - REVIEWEDBY -------------------------------------------------------------------------------------------------------------------- DATE-------- ------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------._ DATE--------------------- Alterations and/or recommendafions:----------------- --------- -------------- ------- - - - - ... ------------•-----------------------------------------------------------------------•--- `lZ -----`------------- -- ------------------------------------ --------------------------------------------- -------- - ----------: -- - ---- ------------------------------------------------------------------------------------------------ ------------------- _ -- ------ --------- - -- ------------------ ------------------------ FINAL INS BY r -- ---- --- -------:-- ae------- �--- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Y 814 North "G" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO. r i