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N + G APPLICATION FOR SANITATION PERMIT Permit No. _. ...:......... (q (Comple+e in Duplicate) �� � Date Issued ---,�_____4 "1 " 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 �p County Ordinance inance 549. JOB ADDRESS A � ] � _ _ ----- !- --__ -------------------------------- Owner's Name --- - ------------- e/ � Phone _ --- - - --------------------------------------------------------------' Address - -------------------------------------------- ---- ------ - Contractor's Name--------------------- -(,,.f/1--- - --- Phone ff Installation will serve: Residence 99---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other /// Number of living units: -/-- Number of bedrooms_ Number of baths -/Lot size ---- __------------------_______________"___--__-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tables ft. Character of soil to adopt�f 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam E] Clay [:] Adobe �iardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [g/FHA/VA: Yes El No El wwrrwc.i TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank o`r cesspool permitted if public sewer is available within 200 feet.) it an : ^ Distance#from nearest well-- Distance from foundation_____________'_-.Material______________._____.______-.______.._______- No. of compartments --- Size--I ------------------------Liquid depth--------------------------Capacity----------------------- Disposal i Distance{from nearest well _ 'S.__ Distance from foundation---JA1P---------Distance to nearest lot line__�G_--___ Number of lines---.------- - Length of eiach line.......R_A`____ ____Width of trench___,.9_,r/--r Type of filter material___ _ ___- _ ._ _ Depth of filte�material-------- ______.Total length___________________o--11>___________-__ P � Seepag it: Distance to nearest�" ____ _--__--Distan m f ndation___ ��t.___. i targe e to nearest I t lin __ �_ _ Number of pits._ --- _---_- lining materia _.Size: Diameter__ -_ __.____Depth_ _____________________ Cesspool: Distance from nearest well---L_-.-------Distance from foundation---------------------Lining material__..___________.________.____________. ❑ Size: Diameter------------------------ - ----------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. �. Privy: Distance from nearest well---- --------------------------------------------Distances fromnearest building-.-.---- ------------ --------------- ❑ Distance to nearest lot line--- ----------------------------------------------- ' t - Remodeling and/or rep ring describe)- k ----------------------- --------- -- ------------------------------•------ ------------------------------=------- ------------------------------------------------;------------------------ ------------------ ------------------------ -----------`--- __ __ f► -� I hereb cer 'fy that I have preparethis application and that the work will be-done in accordance with San Joaquin County ordinances, a e aws, and es and a la+ions of they. an Joaqw cal Heal+li District. k R I caner and/or Contractor) (Signed)---------- -- ---�------ -------�--�------=--------------- -----�---- -----" .-- ---- ----- - -----------=---------------'----- � ) J -------------------------------------- By:------------------- ..�.ev,--- - - - -- ----- --" .-------------t (T�+l�) (Plot plan, showing size of lot, location of system in relati tow Is, buildings, etc.', can be placed on reverse side). r.- FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- --- - ----------------------------------------------------- DATE---- /;-� 4J REVIEWED BY---- •--------------------- ------ DATE------- ----- --_- L 41 BUILDING PERMIT ISSUED-_7"_-- ---------------•--------------------------------------- DATE----------------'------------------------------------------- Alterations and/or recommendations:---------- ----------------------------- -----------------------------N----------------------------•----•-- --------f - -------- r. �� C - _H,. ,lea - .1 !G -�--------:� -------------- yr ---------------------------------------------------- --------------------------------------------------------- -- ------------------------------I--------------------- ---------------------------------------------------- ------------"------- - --------- --------------------------------------- -------------------------------------------------------------------------------------------- 4 F / FINAL INSPECTION BY---------------- -- ------ --- Date-------- -- - - - --------- - - S JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30 est Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES----4-2M Revised 1.57 F.P.CO.