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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 a permit to construct and install the work Herein described. This application is made in compliance w.ithCounty dinance No. 549. r JOBADDRESS AAD LOGATlO ---- � --�------�------�--------- -- --------------- ------------- --------------------...--•----------'------------------- ---------- ti - ------- •--- Phone Owner's Name_ ------_-- -- - ---- ------ ----------- ----- -- rr rr Address-- l__rl- ,'' ------ - - •- ------ -------------- -------------------------------------------------------------------------------------------------- Contr'actor's --------------------------------•----------Contractor's Name--- -• -- ----------------- --------------------------------------'---- ----------- ---- ---------------------------------•-------- Phone------------------------ --- Installation will serve: Residence [Apartment House'❑ Commercial E] Trailer Court [IMol.el [3 Other ❑ Number of living units: :___ Number of bedrooms - - Number of `a_+hs -4--- Lot size "-- -r -- -- __________________________ Water Supply. Public �s stem"❑ Community system ❑ Private M--"Depth oto Water Table`!7'nft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ May Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No41:1 PHA/V.A: Yes ❑ No ❑ y TYPE OF"INSTALLATION AND SPEC[FICATIONS: �`I(No septic tank or'cesspool permitted if p blicrsewer is available within 21�feet) a, ¢� r L �d de M to e"il ----------- . Se tir> ank: Distance from.nearest well__- _ Dista LLA fro foursio _____ No- of "compartments------------ 'Size_ q ----1;pthCapacity.... = ' F _-_ . Dispos fI�d: Distance from nearest well _��___'Distance Pram foundatio __�_//��_t_____.Distance to nearest lot lin ��____._`? t/ Number,of`'lines___._:'____Y__ _ ,Length of.eacli'line______._[1- _ _i!f_=_-_-Width,of"french_______— r iE I' 21 Type of filter mate�i i� ��Depth of filter material_______ _____-__Total ale;gth__�'______�_ _�__________________ Seepage Pit: Distance fo nearest we'll---------------- - Distancefrom foundation___________________.Distance to nearest lot iine__-________._____ ❑ Number of pits----------------------`Lining material----------------_------Size: Diameter-----------------------Dep}h__--------------------- - Cesspool: Distance from nearest well__________ Distance from found'anon------------___......Lining material__-____________________.____________ Size- Diameter--- ---------------- ---- .Depth--- Liquid, P Y------------------------------ 7 --- -----•-- Privy: Distance from nearest well----------------------------------------- _______Distance from nearest bui€ding---------------.-------------------------- Distance-to nearest lot•Iine__– ----- -" --------- _ f- -------- Remodeling and repairing"[describe :---- -------------------------------------•-•---- ! F t --•------------------------•--------•-------:---- -----------------------------------------------.----------•------------------------------------- ----------- -----______.- , l hereby certify'fhat l 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. & t r (Signed)--� ---------- ----- --- �-'--- -- - ---------------------.---------------------------------------------------(Owner and/or Contractor] I --- - -- ------ - - X BY:-------------- ;---- ------•--------------------=,-------------------------- ----------------------------' -------------------(Trtle)---------------------------------------------------- (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 APPLICATIONACCEPTED BY ----'------------- -- -------------------- --------------------------------------- DATE --•----------•---'--------•-------------------- - - . BUILDING PERMIT ISSUED---------------------------------------------------------------------------- ----------- -------- ---. ------------------------------------------DATE------------=----------------------•--•------•-----•----- ' REVIEWED BYRATE » ---------- - ----- --- ---------•-'------------------`-----------._ ...---•------•--I——-- ---------•--- [ Alterations and/or recommendations______________________________ ______________ _____________ .________________________ ____________•_______-______- __._ ________.______________-___________ _-__ __ ___________-_________.____----_-__________----_______.____-__-.____.-f•. ----------------------------------------- ------------- ___-__.__________--_-_--._.----_-__-____ g _-___-_-____ _________.___.___________________.._.-_____ ------------------------_------------------------------------------------------._.__-_--_---_-_.__-____________________----_________-.-________-_______---_-----__---. . 1 5 FINAL "INS'£CTION -------------------- ----- - •---- Date-------------------f w " ..' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lotti, California Manteca, California Tracy, California * ES-9-2M Revised 1.57 F.P.CO.