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62 APPLICATION FOR SANITATION PERMIT Permit No. .____------------- ______ (Complete in Duplicate) i � Date Issued Application is hereby made to the San Joaquin Lo al„Health Dist riict-'ora permit to construct and install the work herein described. This applica-hon1s made in compliance with County Ordinance No. 544. JOBADDRESS AN LOCATION-------- f- -------- =: ._ `---•------------------------------------------------------------------------------- , Owner's Name - -----•--_-- - ------ --------------------------------------------- Phone--------------------•--------------- Add ress Z� Contractor's Name p! Phone----- ---------------------------- ,`<< Installation will serve: Residence ❑ �t Apartment House � .Ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�___ Number of bedrooms _1�Number of baths _Z--- Lot size ---- i�� -. �_'------------------------ Water Supply: Public system �Commun'ity system E] Private ❑ Depth to Water Table 'V eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ bandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [�t' New Construction. Yes ❑ No [tom FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: � � e f Tank: Distance from nearest well-----------------Dista available within 200 feet.) No septic tank or'cess oo1 permitted if public sewer 1s p �nce�rSm foundation------------ ------.Material--------------- ------ V. t�l I No. of compartments--------------------------SizeA------- -„---------------Liquid depth--------------------------Capacity----------------------- Disp al Field: Distance from nearest welLe7iD_ _.Distance from foundation____AP__--__--Distance to nearest lot line___37-_.._.. ��• Number of lines___.______�___. Length of each line_ p , p__.Width of trench____�� _' _________ __ t Type of filter material_ ;_ _� Depth of filte�rAm�erial____Zf_� -____Total length--:-�-_'�f9___________________________ ,r - ---- ----- Seepage Pit: Distance to nearest well-______----------Distance from undation__- _-_JPD-stance-to nearest lot !i e_____.______ Number of pits------ material_ . ti-Size: Diameter_ *Depth____- �____________ p 9 '' Cesspool: Distance from nearest well_________________bistance from ♦foundation------------------------Lining material__._____________________.__._________. R` Size: Diameter------------------------------ -!r—t}i`..«'...----------------------- - ----- r----Liquid Capacity---------------------------gals. Privy: Distance from nearest well--- --------- ----------------------------------Distance from Inearest building_________-----_______________________.._. ❑ Distance to nearest lot line.- --- ------------------ -------- --------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)_----------------_______,________-------------- _ ------------------ - - ----- --------------------- --I- ` 1 W-„G�--- ------- -- ---- - --------- ---------------------- ------------------------------------ -------------------------------------------------------------------------------- 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. ---- --------------- ------------- ----------------=---------------------- r Contractor) I ---------------------------- By:--------------------------------------------------- �,fem - r.- -(Title) --- ------- -- ----------- (Plot plan, showing size of lot, location ofrelation towells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- REVIEWED -- ------ --------------- --- - --------------------------------------- - �BUSDNG PERMIT ISSUED------------------------ ----------------------------------------------- DATE----------- -' ---------------- Alterations and/or recommendations--- ------ ---------------------------------- -------------------------------- ---- •- ---------------------------------------- ---- --------------------------------------------------------•--•------------------------------------------------------- ,�•- --------K -------------- ------------- -•----------------- ----------------------------------------•------------ ------------------------------------------------------------------------------------------------------------- ---------------- -- --------------------- --------------------------- ----------------------- FINAL INSPECTION BY:.- Date----- -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street . .;,1132 tS amore S!r of y 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-4-2M Revisea 1.57 F,P.CO.