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5d APPLICATION FOR SANITATION PERMIT Permit No. G�' (Complete in Duplicate) Date Issued ..-�l_7/j_.y 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------ - 1 J Owner's NamoPhone--------------------•--•------------ `�y� Address---------------------- = � - ---a�G-'-' Contractor's Name--------------- =-- ---- - - - ---------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �I�� r h-_JIM------ Number of living units: __/--- Number of bedrooms __�_ Number of baths _f _____ Lot size ______ __ _______________________ Water Supply: Public system ❑ Community system ❑ 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 ?R"New Construction: Yes ❑ No FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) ptic rank: Distance from nearest well—--------------Distance from foundation--------------------Material________________.______________________.__-__- No. of compartments-----------=------------ Size--------------------------------Liquid dep.th--------------------------Capacity..._------------------ Dispo al yield: Distance from nearest well___.--"__.Distance from foundation-----/e_�__Distance to nearest lot liin7e___- ____- y Number of lines__________/-_.--- j-Length of each line__________ _ __________.Width of trench_._ _ _____ r____ r - . --- �_� � 7 � Type of filter material----�_'��___ .__Depth of filter material____��''a__�___Total length____ ________� ' __ Seepage Pit: Distance to nearest well______-----_______Distance fr m f ndation__ � .....17� s � Deptn_____-��-Number of pits.---- ------------Lning mateaSize: Diameter.-- - --------------------------- r Cesspool: Distance from nearest well--------_--------Distance from foundation-----------______`..Lining material______.______-.------___________.____. ` ❑ Size: Diameter------------------------- ----------- Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------ -------- ----- --•----------------------------------------------------•--------------------------------------- Remodeling and/or repairing (describe)----------------------------=-�� ----- -- ----- -------------------------.....-•--------------••----•-----•----------------•--=----------------------------•------ ----- -- ------------------------------------------------------------ --------------------------------------------------------------------=------------------------------••-•--------------•---•---------------•---------------------- ----•-------------------•---------------------------------- --------------------------------------------------------=-----------------•------------------•-----------------•-----------------•--•----------------•-•-------------------• -----------•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. (Si ned g ) -------------------------------(�'j/or Contractor) moi '--' --------------(Title) �1 .��a By:-------------------_----------- - ----- - (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY x APPLICATIONACCEPTED BY-5�--------- ------------- -------------------------------------------------------------------- DATE--X4------------------------------------------------------ REVIEWEDBY------------------------------ _ DATE---:5- ----------------------------------------------------- 'f ` BUILDINGPERMIT ISSUED----------------------------------------------- ------------------------------------------------------ DATE----�-------------------------------------------------- Alterationsand/or recommendations-------------------------------------- - -------------••------------------ ----------------------------------•-----•--------------•---------------------------- --------------------------------------------------------------------------------------------------- -------------•--------------------------------•• -••--•----•-•----------------------------------------- f --------- ------------------------------------------------------- --------------------.--------.--------------------------------------- s - ----------------------------- ------------------------------------------------------ ------ 6-7 Date - ------ - - -------------------------------------------- FINAL INSPECTION BY---------- --- -- - ---- r r- SAN JOAQUIN LOCAL"HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C"Street I Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2M , Reviseci 1-57 F.P.CO.