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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �llv�d 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. #. D�3— JOBADDRESS AND LOCATION----- ` ----------------------------- ---------------------------------------------------------------------------- Owner's Name- -- -- ------ --- ---- - -• ----- ' -----fX"'4,------------------------------------------ Phone------------------------------------ Address---- + �--- - •------- -@----------------- ---- -- Contractor's Name---------------------�a-..... ------------------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ �M/ottel ❑ Other -------- -------- Number of living units: __.._.__ Number of bedrooms ___ _._ Number of baths ____-_ Lot size -----7/�k ----------------------- Water Supply: Public system ❑ Community system U?01'plrivate ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravei ❑ Sandy Lo ❑s#Clay Loam ❑ Clay ❑-.,�,,.Adob�❑ Hardpan [ � Previous Application Made: Yes ❑ No [I"New, Construction: Yes ❑ No R.-1--IFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' R it :� e c Tank: Distance from•nearest well-----------------Distance from €oundation--------------------Material____._.__-____________________________.____-__. No. of compartirents--------------------------Size-•--------------- --------_Liquid depth------------------------._Capacity----------------------- Dis os Field: Distance from ne ra est well_________________Distance from foundation--------------------Distance to nearest lot line_______--____-- Number of lines------- --- i+` Length of each'line ' Width of trench Type of filter materiaL_____.____f4_-___----Depth of filter material______________________Total length__----------______-_____________________ t If r / Seepage Pit: Distance to nearest well.-0704__ Distant om oundation_1,Q�_____-Distan;� to nearest lot line [� Number of pits- -cA------_-.__Lining material QtA____-Size: Diameter__ ;j_ --- _.___Depth_______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______._______.____.-_--.----------._. ❑ Size: Diameter----- --------------------- --------Depth----------(-----------------------------------------Liquid Capacity----------------------------gals. ; Privy: Distance from nearest well_______________________--___------ ----------Distance from nearest building______.._-_____________________.____._--. (�y �' ❑ Distance to nearest lot line- -------------------------------- L----------------------- ------------ -------------------------------------------------------i, � Remodeling and/of repairing (describe}:--- ; --------------•----------------------------------- '--------------------------------------------------- ------=------------------------=------------------------------- --- ---------------------------------------------------------------------------jy, ---- ` ._ ---------------------------------------------------------- ---1 hereby certify that I ha prepared this application and that the work will be done in accordance with San Joaquin Coun ordinanc es, St t laws, and ul stand re Iations f the San Joaquin Local Health District. J 5i ned ( g }A ) " _= - ---------- - ------------- caner an Contractor] }. sy:. -------------------------- --(Title)--------4079, — ---------------------- - --r-� (Plot plan, showing size of lot, location of system i .r lation to wells, buildings, etc., can be placed on reverse side). - - FOR DEPARTMENT USE ONLY APPL]CA71 N ACCEPTED BY --------- • .---------------------- REVIEWED`-BY-----•-•-------------------------------- -------------------------------------------------------'--•-------I------------ DATE----------------------------------------------------------- BUILDINGPERMITISSUED = ---------- -------------• DATE------------------------------------------------------------- Alterationsand/or` recommendations--------------------------------------------------------•--------------------------------------------•-------------------------•------------------------------ -----------------------------------I----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ---•------------------•-•-•-----------'--------------------------•------------------------------------------------__...--------------------•-------------------------------•------------ 6 --------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------------- -------------- I -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- OF • ?'`a FINAL INSPECTION BY:__444,0��--------- --------------- Date - -- - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 Revises 1.57 F.P.CO.