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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �f I Date Issued /_14_-/-,__ _ lication is hereby made to the San Joaquin Local /// pp y q a 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_____ /------------ --- ---(� ��r ---------------------------------------------------------- Owner's Name------------ -----10------------ ------ --- ------------------------------ ------------------------------------ Phone------------------------------------ Address----------- ----------1.7,1/------ --- ----•----------------------------------•----------------------------------------------- ----------------- Contractor's Name---------------------------- _ Phone./416(-W,07----- ---G�- - -n•---�----- - ---------------------------------- - - - -------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms _ Number of baths __ _ Lot size -_-_--s�d_____, _.I_ _ ____________________ Water Supply: Public system ��ommunity system ❑ Private ❑ Depth to Water Table .�d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [t�Hardpan ❑ Previous Application Made: Yes ❑ No 9?--'New Construction: Yes ❑ No D�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) gC Tank: Distance from nearest well-________________Distance from foundation_________-__-______-Material_______-___-___.__._____________.____-..______.No. of compartments--------------------------Size-------------------------------Liquid depth---------------- ---------Capacity---------------------- i d: Distance from nearest well�dh&._.Distance from foundation_---_,1Q_______-Distance to nearest lot line____S____..__..— Number of lines----------/__________________ ___Length of each line___.__®_-__�-_____--Width of trench----a_f��--_______._._--__-- t Type of filter material----SrPo� Y-Depth of filter material-----/9----------Total length--------------- _ __________________ Seepage Pit: Distance to nearest/ ell d-'�_____Dista ce m ff°undation___� � _---__-.Dista?nce to nearest lot line----------- _ _ Number of pits______ ___________Lining material !_�,C______Size: Diameter---- - -. -------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-_.____________--------_-_________-_. ❑ Size: Diameter--------------------------------------De th------------------------------------------ --------Liquid Capacity-. ---------------------gals. Privy: Distance from nearest well --------_------------------------.-------------Distance from nearest building___-______--_________--______-_-_____ -. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ j ---------------------------------------------- ----- ----------------------------------------rte = ---------------------------------------- ---------- - I hereby cer ify th t---1 -- . prepay d this pp ication and that the work will be done in accordance with San Joaquin County ordinances, tete a u es and gulatiothe San Joaquin Local Health District. (Signed)--------- - - ---- - - ----------- ------- V- --------------- wrier and/or Contractor) By-------------------------------------- ---- - - ------------- - ----------------(Title)--------- ------------------------------------------- (Plot plan, showing.size of lot, locatio of system in relat' n to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- -------------------------------------- DATE- REVIEWED ATE-REVIEWED BY------------------------•-------------------- ------------ - ----- ------ ----------------- - ------------------------ DATE---- -- - ------------ ----------------BUILDING PERMIT PERMIT ISSUED ----------------------------------------- DATE--- Alterations and/or recommendations:-------- ---•-- ------------------------------- t � - - -----------------------------------------------r---- ---- ------------------------------ --- -:_------------------------- - L-tYIJ�.q-1101-rr....E - -------�- ------.5 -- .. ' ----- ._ --------------------- 1 4 - ----------------------------------------------- Date FINAL INSPECTION -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P.CO. i �