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i APPLICATION FOR SANITATION PERMIT Permit - ,- t li D l (Compete in Duplicate). Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct ands install the work herein described. This application is made in compliance with County Ordinance No. 549.E , JOB ADDRESS AND LOCATION------J_705 `/------ e ._1�� ✓------------------- � ------------------------------ - -��-- ------- - - ----- -- - - 1 Owner's Name-----y = Phone Address_ --•---- ----------------------------•--------------------------------- # s, -- ----------- -•--------------- -- ------------ - . Contractors Name__'___________ __ __ � Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel❑ Other ❑ f _ Number of living units: ---(--- Number of bedrooms ._dumber of baths ---1--- Lot size !- -- ------------------ Water Supply: PublicsystemLl( Community system El Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application,Made: Yes ❑ •No `''� New Construction: Yes ❑ No FHA/VA:.Yes ❑ No TYPE OF INSTALLATION AND SPEC•1FICATIONt:= (No septic tank or'cesspool permitted if public sewer is available within.200 feet.) Septic Tank: Distance from nearest well______._ f�fstanc om foundation�� ____,_____.Mat dal___ ___ -- No. of compartments_____- ------------Size_ i ��-------Liquid depth-•� �------------CapacitY----_•------------- - Di osal Id: Distance from nearest well_--.=:,..._____..-Distance from foundation____________________Distance to nearest lot Number of lines------------------------------`-- "Length of each line------`---- `"Width of trench_---------____-- f-------- --------- r - _._____Total length________. _ .. Type of filter materiaL___._.___"--------------Depth of�filter,ma ferial__________ --- -- ------------------ G Se aqe ,it: u Distance to•,nearest well____------------------ Distance from foundation '_________. i5ta of to nearest lot/pe--_-__..___-___._ 7wrlNumber of pits----------------------Lining material----_------------------Size.- Diameter_ ------Depth_._- Cesspool: Distance from nearest well--___._________-Distance from foundation--------------------Lining material___--------________._____- _-______. ❑ Size: Diameter ---------Depth --------------------Liquid Capacity gals. ---- n Privy: Distance from ri-earest weli.'_::`____________________________________________Di`stance'from,nearest building------------------------------- 1 ❑ Distance to nearest lot line y -'..... ------------------- ---- --------------------- Remodeling and/or repairing {descrbe :_____� ---- �-- ------l�L6------- � L� > t F � 17"l7 --------------------------------- ------ ------------ ------ -- -•-------------------------------•---------------------------';------------------------------------------------------------------------------------------- ! hereby certify that I have prepared-this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and ru elsregulations of the San Joaquin Local Health District. r. LP "h (Owner and/or Contractor) (Signed)_ --s---- ------------------------------------------ (O d/o -- ------- ---- ---- ------------------------------------------------- Tale -------------------------------------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,.FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY------------------- --- --- - DATE----_--____-- ---------t��------------------------------ DATE----- - ----------------- ------------------- REVIEWED ----- - REVIEWED BY-------------=------------------------------- ---- ---- DATE f W'----------------- BUILDINGPERMIT ISSUED-------------- ----- - --- ---------- -- ------. DATE-------- - --- - --------------------------------•--------- Alter do and/or recommendations-------- ------------- - ------� -- - _ - .--• ----- -------- -- - - ---- Date--- -- ------------ -------------------------------- FINAL INSPECTION --------57�__ ----- ---------------------------- 4 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 E5-9--2M : Revised 1-57 F.P,CO.