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APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) !� Date Issued Application is hereby made to the San}Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-----_ ""O_ __-__-- .� ---------C ------------- •-- --------------- Owner's Name-------E.--.. _�_ _ a - T•- -------- - - Phone-------- Address----------- --:--•--- - ----------- Contractor's Name-------- ,, '' • - f E -"+4 ------------ Phone---•--•-------------•-------- = ! -- - -------------------------------------------------- - -- Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ TrailertCourt ❑ Motel ❑ Other ❑ Water Number of living units: _-1 _Number of bedrooms Number of baths ____ Lot size Supply: Public system Community'system ❑ 'Private ❑ Depth�to Water Table -------- ft:,� Character of soil to a depth of 31 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E]Previous Application Made: Yes E] No'D< New Construction: Yes No E] FHA/VA: Yes F] No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) apt' Distance from nearest well -,___'Distance from foundation-------------_------Material_ _______:___________"___._.___� No. of compartments = Size-------------------- ----•--Liquid depth----------------------- f Capacity----------------- isposal Field: Distance from nearest we6�_G_"--!__.Distance from foundation!_._-I_b____-----Distance to nearest lot line_____:__-____ Number of lines________ - ength of each line___ l�_� : ___..Wid+h of trench______ .- Type of filter materia!- _ I�'of filter material----1___ --------_-----Total length----- Seepage Pit: Distance to .nearest well--------------_'_:___Distance from foundation-_—____ __.,Distance to nearest lot line_________________ p - g material__.--------_""-- --Size:'Diameter-------------- - ❑ Number of its----------------- ---Linin Depth . Cesspool: Distance from nearest well------------------Distance from foundation_-__________-_____- .Lining material--- ❑ Size: Diameter--------------------------------------- Depth---------------------------------- ----=-----------Liquid Capacity---------- gals. O , , Privy:' Distance from nearest well_.:------ '___.__F.--___.-----------------Distance from "nearest❑ building-___-_____-------_________ - Distance to nearest lotdine------------------------------------------------ - - Remodeling and Vor repairing describe :____ �v -------- ---••-----• --- ---------- ----------------------------------------------•------- ----------- ------ -------------------------------------------------------------------- •--------•----- 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. V (Signed) 1 a ( / Contractor) ___________________________-"___-_ -______ l f -------------------------------------- By:--------------- __ Y a e caner and/or o ct o ntra or (rtl ) ------------------------------------------------ �� a (Plot plan, showing size of lot, location of system in ,relation to wells; buildings, a+c., can be'placed do reverse side), FOR DEPARTMENT•USE ONLY r APPLICATION ACCEPTED BY-------------------------- ___ _ --- --- ---- DATE----- REVIEWEDBY ---------------------------------- - ------------ -------I------------------------=---------------------- ---------- DATE---- ------------------------ UILDlNG PERMIT ISSUED-------------------------------_--- -- DATE------ --- -------`- ---- " Alterations and/or recommendations:'______________________ - -- - 1>-----------`-----"-------"--"------- -----------•---------•------------------------ ------------------------ 11---- ---------- FINAL INSPECTION BY:_4 s-___- - - Date--- -------------- --------------------- -- ,l-� ---- --- - -_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street L 132 Sycamore Street _ 814 North "C" Street s Stockton, California Lodi, California,. Manteca, California Tracy, California ES-9-2M , Revises 1-57 F FCO.