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1d APPLICATIONuFOR SANITATION PERMIT Permit No9__! 'T f (Complete in Duplicate) Date Issued -_-_ Application is herebyi made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is mai a in compliance with County Ordinance No. 549. CATION Z--- _�. (r -------------------------------- JOB ADDRESS AND, --- ---- - . Phone----------------------------------- Owner's Name----- -� Address-------------5 .' x! ...---..A). ----------------------.....--------------;=------------------------------------------------------------------------------ I Contractor's Name---=. - Phone---------------------------- Installation will serve.i Residence [Apartment House E] Commercial. E] Trailer Court E] Motel ❑ Other [] I I de if Number of livig ln units: -- ----- 01 -.- Number of bedrooms -- -_ N m _ber of i3atEs-_-___ Lot size _ p--.--Ok- ----------------------- I Water Supply. Public system Community system ❑ Private ❑ Depth to Water Table A/jq ft. Character of soil to �depth of 3 feet: Sand ❑ Gravel E] Sandy Loam F] Clay'Loam ❑ Clay E] Adobe�ardpan ❑ Previous Application (Made: Yes ❑ No & New Construction: Yes•PR--No ❑ FHA/VA: Yes P— No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fan 11 or'cesspool permitted if public sewer is available within 200 feet.) , �g ® E p Distance from nearest well-----`�'-_+.'-�---__Distance�from foundation---I�_�__......Mater•ai .6-6 -____-- Se Septic /-------- No. of compartments._._.`..__...__._ p�ta __ j(P___Liquid dept__._ ------------Capacity --__ - I� Size__ /� Disposal Field: ..Dyistance from nearest well ---.-Distance''from faundati ` ____.Distance to nearest lot line________-__. r ,:Number of lines_____✓._____ _______ ______Len Length of each line____ Ei alti4�Jth of trench ---- ---------------- �_ Type of filter material_ p Depth of filter material -- --- __� f_-_ g Total length r Seepage Pit: Distance to nearest well____------Distance,f m fou atipn__-a�+_! .'.___. ro/re to near ?lot line---�-_-_-. y Number of pits----___-________Lining materialSize: Diameter_ ____-_-___Depth__ _ --- --------- Il Cesspool. Distance from nearest well-----------------Dison e from foundation--------------- - Lining material------------------------------------- ❑ Slze: Diameter--------------------------------------Dere---=--------------- ------ ---------------------Liquid Capacity----------------------------gals. Privy: - Distance from nearest well-------------------------------------------------Distance'from nearest bui ------------------------------------- ❑ Distance to nearest lot line------------------- --- -- - ---- Remodeling and/or repairing (describe):-- ----- .. `� --- - -- -------------------------------•------------------------ ---•--•--------------------•------ ----------- ------ ---------------------------------------------- F1 _____________________________________._.___-__-----_-____-_--.--------------___-_--___--___---_-_-_---------_-----____-_-_--__--__-----_-_---------__-----_-..-_---_-______-___-__-._._______.______._______________.___._._.. i ___-_______________________._______:}---.-----__-_-_-__-_-__--__-----___-_--_---------------------------------._______________________________-_..__-._�______________________________.___________________________._________.. I I hereby certify.'fhat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawaandles and regul tions of the San Joaquin Local Health District. (Signed)----------------------° �--- ----------------- ---- -�-- - ........................ ---------- ---------------;-----------------------(�r Contractor) I ------------ I BY�------------------�---•---------------------- , ------ -- --- - - ----------- - _,- --_:-_ .-,,.. ,(Title)----- ------ -------- - i (Plot plan, showing size of lot, locati system in�ela4ion fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------------------------------------ DATE REVIEWEDBY----------�-------------------------- ----------- ---------------------------- DATE--------r-g-- -----------------•----------------------- BUILDING PERMIT 1!SSUED-------------------- -•--------- ----------------------------------------.- DATE----------F----- ------------------------------------------ Alterations and/or recom endations: ---------4-------------------------- --------------------=---------------------------------------------------------------------------- --------------------------------- } 7 3/ ------�� --------------- I N - �. ------------------------------------------------------------------- ------ FINAL INSPECTION BY------------------1 =14-------------------------------- - Date------- -6 f - SAN`JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh.;Amer;iea.- er ete-•-�--�-.. 300 Werk&4_streot . `>,132,S cam'* Street 814 North "C" Scree+ Stockton, Californnii Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.00. l;+