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APPLICATION FOR SANITATION PERMIT Permit A (Complete in Duplicate) � „ Date Issued ___ _'�/1' A Thips aplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pplication is mades in compliance with County Ordinance No. 549. 7t-1))-) = - - � a 49 ----- ------ f� Owners Name--JOB ADDRESS A D ATI -. Pho _ '„_9 o� f--____ - ----- - --- AddressA1 ---------- ----------------------------------------------------------------------------------------------------- u Contractor's Name--- ,-------------------------------------------- Phone--------------------------------- Installation will serve: Residence-C Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _._. Number 77of bedrooms'/'"""Number'of bat0__1___ Lot size ____ ________________________________ Water Supply: Public sys+em ❑ Community system ❑ Private. Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,] Clay ❑ Adobe ❑ Hardpan R Previous Application Made: Yes ❑ No 48 New Construction: Yes ❑ No,� PHA/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 nearesf.well__=_=..=-_Distance from,founddation__-----------------_Material------.------------_------__.___________________. ❑ No. of compartments---------- ---------------Size--------- ---------------------Liquid depth------------------ -------Capacity---------------------- 00 Disposal Field: Distance from nearest well.- r-i ._.Distance from founds ' n__ . Distance tto nearest lot line___ Number of lines_'_-____"_:.__. __ ._ "_ ngth of each line__ �____________________Width of french-,X-Y.f' r --- - -------- Type of filter materiae' epth of filter material---f Total len th__7 i 9 F g a f Seepage Pit: Dis#ante to nearest well__t___---------_------Distance from foundation_____________=___..Distance tonearest lot line----------.------ ❑ Number of pits----------------------Lining material I ------------:----------Size: Diameter----------------3------Depth--------------------------------- 1, Cesspool: Distance from nearest well----*----------Distance from foundation--------------------Lining material__________________________________- Size: Diameter------ ❑ --------- - Depth -------C Liquid Capacity - gals,_ Privy: Distance from nearest well------ I Distance from nearest building ❑ Distance to nearest lot line ----------- ----�---------------•---------- ------------------I---•-------- Remodelin and--or repairing describe----------------------------- --------------- - -------------•---------------- ---- ----•-------- -------- --------------= --- -------------------------- -------------------- -------------------------- --------------------- -_ S -------------•----• ----------------------------------------------=-----------------------------_•-----.....• -------------------------------------------- I -------------------------------------------------------- -___y - _.__y__ ___ - prepared- __--------------------------- s-__ ______.__-•`and that the work will be done in accordance with San Joaquin County [,hereby certify that I have thi -a p p lication' ordinances, State laws, and rules and regulations of fhe;9an-Joaquin Local Health District. Si ned y ° NA t �f .( g } `` _ == .- _ Owner and/or._ _ } -7- �- � - � T�T Contractor) BY:------------------ ---------------------- - ----------------------------'--------- ------------------�-----------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, loca+ion of system in relation to'wells, buildings, etc., can be placed on reverse side). _ i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS© BYE - - - DATE = Q �--------------------------------- .- ._- 1 ---- ------- DATE------------------------ REVIEWED BY-------•---------------------•-------------------------------------------------------- - - - - -------- ---------------------------- BUILDING PERMIT ISSUED-----•-•--------------------------------------------------------------------------------------------- DATE----------------------------------- ------------------------- Alterations and/or recommendations:----------------------------------------------x.................-----------------F--------_---------------------------------------------------------------- ----------=------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------•--------------- wa FINAL INSPECTION $Y Date ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Reviseo 1-57 F.P.CO.