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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 with County Ordinance No. 549. JOB ADDRESS AND .LOCATION---• ------ -- ------------------------------------- Owner's Name_ Phone--------------------------------•--- Address-----------------------•----------------- _ C� - ---=---------------------------------------------- ------------------------•---------------------- Contractor's Name�V' .1- DAY&NIGHT ----------------------------•----- Phone__AV__A_7&51---.6 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. Number of living units: -__ -_ Number of bedrooms --J-.. Number of baths ---/--- Lot size .-- -S'`-_� -f _ `_�--------------------- Water Supply: Public system; t Community system ❑ Private ❑ Depth to Water Table __A -&ft.' Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [] .Clay Loam El .Clay ❑ Adobe Hardpan•❑ Previous Application Made: Yes E] No New Construction: Yes o ❑ FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4 tic a Distance from nearest well--- _Distance from foundation_--_- ' ---.Material--mac -4- _____ y s k4 No. of compartments-----}-wf�-------- --Size- ` _ _f----Liquid depth------- ------Capacity._'&I -----_---- Disf pisposal Field: Number ofol lines well_ ,n - pta of rom each line foundationrte_— Wsdthcoft#ranch nearest I Ie.' -_-- ---N Length P' Type of filter material-- - _ �- Depth of filter material__--- ��-....Total, length----- -`-- Seepage .it: Distance to nearest WO --------Distance_from foundation---/__/___,P_'_"___.-_.Dista_nce to nearest lot ---_ Number of pits---1j---------------Lining ma#eriaL`C-,_r_4--------Size: Diameter-_-- -, '- --- -.Depth---- �j -r--------------- .. a . Cesspool: ;". Distance from nearest well-----------------Distance from foundation- ----------------- material__..--_---.---------__--_----_--... �! ❑ Size: Diameter------------------------ DeptH------------------------------ - Liquid Capacity— q -------..gals•9 _Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------_-----------------•----------. ❑ Distance to nearest lot lire--------------------------- --------------------------- -------------- Remodeling and/or repairing (describe):---- -�.- .,�x-�.at?:.� a�:�.��-��=t`--=-��--p-----------•----•-------------------- ---------- ------------------------------• -----------•------------•-----------------------------------------------------------------------------------------"----=----------------------------------------------------•--------------- I hereby certify that I have prepared this application and that the work will be done',-in: accordance with San Joaquin County ordinances, State s, and rules a lations of the San Joa uin Local Health District. - 9` EIGHT q {S _?. etirTank Service +i ned) - _ ----------- Contractor)2-704a BY:------------ -----------------------flockhm,-Cialif.------------------------- - -- Title) (Plot plan, showing size of lot, location of system in relation tow S,'buildings, a+c, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -± = DATE a`� REVIEWED BY ------------------------ --------- DATE ffi / v BUILDING PERMIT ISSUED - ------ ----•---------- ------ DATE------ - --------------------- ------------------------ Alterations and/or recommendations..---------->a- - -------------•---------------- ------------------------------------------------------------------------------------------••----------------------•-------------•-----------------..... - - - - ---- - 1 ---------- -5 c �i --------------------------------------- y - FINAL INSPECTION BY:.--,. Date Q--- ---------------------------- SAN SAN. JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi,'California Manteca, California Tracy, California ES-9-21V Revised 1.57 F.P.CO.