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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 60— /2 ._ Date Issued - -----/id,S--� Application 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. i JOB ADDRESS AND)LOCATI i � C l-C r E a r ------- - --- k �� _ ! c__� -i ✓ Owner's Name-------- ------------= � - j •� ------------------ ----- -------------------------------------..,"Phone-- Address -------7�.'�._c17----------------- Contractor's Name-- -------- ., o .,. i � //�� --•--- ......................... - ----- Phone rsslnstallation will serve: Residence [e- Apartment House E] Commercial El Trailer Court E3 Motel E] Other Ej =w Number of livin units: g I------ Number of bedrooms _ __ Number of baths ---- Lot size __-_ __K __ ______________________-•.__ WaterSupply: Public system K]"'Community sysem ❑ Private ❑ Depth to Water Table ______ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑�A 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.) Septic Tank: Distance from nearest well---"5'()_fstance from foundation_-_ �0__.f.._...Material__--- `( No, of.compartments---- 9—t---------------Size---._ 1 X - _ y__---Liquid d - epth_ --`. , .Capacity---- --------- tf -_--- Disposal Field: Distance from nearest well' : ----- )?`Mance from foundation-- /d Distance to nearest lot line_---------------- l4J' Number of lines_________ ____ _ __ __ ---Length of each line------------ Width of trench_________ z Type of filter material---- Depth of filter material___.___ _ _ -Total length__-__------ Seepage Pit: Distance to_nearest well ____-. ______Distance from foundation-------------------Distance,to nearest lot line__.___ El Number of pits__. .. __,______Lining material-----------------------Size:'Diameter------ -----Depth_________ Cesspool: Distance from nearest we ll................. Distance from foundation--------------------Lining material--_____-____--____--____--_____ (,�" ❑' Size: Diameter--------- _ 1 Depth-- - --- --- --- - - ----- - -------Liquid Capacity �- gals. ' Privy: Distance from nearest well -- -- --- --- --_ -Distance from nearest building - ❑ Distance to nearest lot line '--- -------------------------------------------------------- Remodeling an / r repairing (de tribe) C�' "- w-off =T```v sr4' (_ 9 V� c - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, and r les and regulations he San Joa uin Local Health District. (Signed).X.-( er------- � _ . - ------------------------------------------Crwrier and/or - _. . Titl - - --------------------------------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can_ be placed o reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - 2 -� . DATE , 3 - REVIEWED BY- ---------- --------------------------------"---- --- --- --- -- = _-DATE- - ----- ---_ ---------------------------------- BUILDING PERMIT ISSUED ------ DATE - - = Alterations and/or recommendations:-----------------.------------_ � 3 -------------- - --------------------------••------•------------------------------------- � -} /� - - •-- .k�2/ f T -------------- -- - ------ -- >�� -- - - ' 01. ot FINAL INSPECTION BY:. ` - - -------------------------------------- - ---- ------- Date 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 f ES-9-2M Revised 1.57 F.RCO. I r