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�i APPLICATION ,FOR SANITATION PERMIT Permit No SJ t f (Complete in Duplicate) *_A?Date Issued ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_____._---C7-0?-47 y /�� --------------------------------- Owner's Name C�__s --._. Phone- r�--��--47-.- ------------- ----- --------- A.- .- _. Address__. ---- - ------- --------------- -•------------------------------------- -•-- - ----------------------- -- --- --- ----------- Contractor's Name----------------------- . = = Phone. `g4-d-7 --------------------------------------- - Installation will serve: Residence Eg-"Apartment House ❑ Commercial ❑ Trailer Coui-t ❑ .Motel ❑ Other ❑ Number of living units: /-___ Number of bedroomts _ Number of baths _-1_-__ Lot size ---Fd_-/,X ---•-- Water Supply: Public system ❑ Commuriify system kr_�Frivate ❑ Depth to Water Table .y�7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes-E] �No [ New Construction; Yes E] No D"FNA/VA: Yes ❑ No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool'permitted if public sewer is available within 200 feet.) pfi Talk: Distance from nearesr well_________________Distance from foundation--------------------Material______-_______.__..__---.____.___-_.- No. of compartments---------- ---------------Size--------------------------------Liquid depth------------- ----- Capacity ----------------------- is al eld: Distance from nearest wef! _Distance from foundation_________:_____-_.Distance to nearest lot line__________._--___ Number of fines-----------------------------------Length of each line-----------------------------Width of french Type of filter material--- .In--------------------Depth of filter material-----------------------Total length---------------._-______-_____ ---___-__._ Seepage Distance to nearest ----Distance op f undation----�lJ.�--_-_-.Distant e to nearest lot line_-__*5 61 1_.__ Number of its.__.__ _---._ p Lining material-- ------- -- - ------Size: Diameter---- ----:---.. -Depth__- ------_-- (,, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________.___-__________.________.__ "V ❑ Size: Diameter-------------------'----- -------------Depth----------------------------------------------------Liquid Capacify----------------------------gals Privy: Distance from nearest well----__.----__---_ _-_ -------------Distance from nearest buildin . - ----------- --- ❑ Distance to nearest lot line------------------------------ --------------- Remodeling and repairing (describe):____ @/ -__ - - -- -- - ------ -- ------------- I . ----------------------------------------------=----------- -------------------- -----------------------:------------------------------------------------•----------------------------------------------- I hereby ce tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la , and rule and ulations of the San Joaquin Local Health District. (Signed) ------------ -------------------------------------- ----- caner and/or Contractor) 6' -- -- ---- By:----------- --------- ------(Title) `- --- --- ------ ------------------------ ot plan, showing.size of to+, location of system in.relation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------ - --------- DATE- ...__--------•- ------------------ - - - ------------------------------ -- -------------- REVI WED BY---------------------------------- - ------------------:--------------------------- DATE-- . BUILDING PERMIT ISSUED---------------- - - ----------•---------•-------- ------------ ------------------------------------ DATE-.---.------ - ----------- Alterations and/or recommendations:---------___________________._ ------------------------------------------------ ---------------------------------------------------------------------------- -------------- ---------------------------------------•---------------- ----------------•----•- - FINAL INSPECTION BY:.._ __ - G - 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 ES-9-2M , Revised 1.57 F-P.CO.