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F i)11� 6 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date-,�,Issued__-�/- ...�P•__U. This Permit Expires 1 Year From Date Issued ,; ' Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with CountOdi 549 ' �`S / �' _ ------•------1 ------------------- -----••----------- JOB ADDRESS AND LOCATION_.__ _ _ ----------------- ____________ JJ—� C.6yy. i1Owner's Name---------- Phone-- Address--- hone__Address--- - ;p ---- -- -•------•-•-- ----- -------•--••---------------------------•---------•- c : �� rZ ------ Contractor's Name---------------------------------- ------ -. --- Phone.... .. i Installation will serve: Residence' Apartment Houser❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: _ __ Number of bedrooms __ - Number of baths -------- Lof size --------- ------ Water Supply: Public system 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 U3/Hardpan ❑ Previous Application Made: Yes ❑ No E- New Construction: Yes V No ❑ FHA/VA: Yes ❑ NoR TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seweros aYailable within 200 feet.) Septic Tank: Distance from nearest well_�e 1 _Distance from found ion----.1G�__-Materi __ [� No. of compartments, ._.-_�--._�- __size-----------c _ - Liquid deryp/th_ -------Capac--ity__-__9-_-__-?_-_,_�-gX _--�,-f_5__. -._ ._-- �-- Distance from oundation_____�_l / _ Distanconearest lot li�Disposal Field: Distance from nearest,weil - e ..... .... Number of lines____________ %r— _____- Length of,each line________---� Width of french.------ Type of.filter material__ --Depth of fer material______ _ - Total len th �_ dation_ /_ --------Distance to nearest lot (me _ .SeePage Pit: Distance to nearest well----- - ' Distance from foun Number of-pits Lining material-____.. of .Size: Diameter-----` ��,t-----Depth--------- ._ D�Vdn d1 - --_--------- CesspoolDistance from-nearest well------------- Distance from fou dation____________________Lining material:._.._._______________.___________El . Size: Diameter----- ------------------------------Depth--------- ------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance froV nearest well------ ;h,-:---- ,�,-;- 9 _------ --------------------- Distance from nearest building ❑ l` Distance to nearest of line----------------------------------------------------------------- Remodeling and/or repairing (describe]:--------- ------------------------------------------ -•-----•-------- -------•-------------------------•--------------------------------------- i 3. ___________________ _ _ _ _ __ - 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. f (Signed) ------ ..........(Owner and/or Contractor! ' By:------------------------------------------------ ---------N: ---------- ----------------------------------------------(Title)-------------------- ------------------..._..- ------- ------ (Plot plan,,,showing size of lot, location of system^in relation to wells, buildings, etc., can be placed on reverse side). I FO DEPARTMENT USE ONLY ' - =------------------------ DATE----=-- ---- z ,C? ---------- APPLICATION ACCEPTED BY------ .__ - ____ ��- - - REVIEWEDBY------------------------- ----------------- -------------------------------------------- - ---------------------------- DATE----`--./------------------------------------------------- BUILDING -. -•---------------------------•------------------- BUILDINGPERMIT ISSUED------------------------------------------------ --- `----- -- ---------------- DATE------------------------------------------------------------ Alterationsand/or recommendations------------------------------------------------------------------ ---------------- -------•-•--------------- ------------------------- - c �-- = ----- ,` FINAL INSPECTION BY:---� .__ -----=- ---------- Date-------- --------------------------------------------- SAN -- --------------------------- ---------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132-Sycamore Street 8.14 North "G' Street 'I Stockton, California Lodi, California Manteca, California Tracy, California .� ES-9-2M Revised 5-'59 F.F.Co.