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rmit No. ._(..1._-_�.. ....- APPLICATION FOR SANITATION PERMIT Pe t li {Complete in Duplicate)_ Date A Issued ___-- -�_--- ••--�. Application is hereby made to'the San Joaquin Local Health District for a permit to construct's d install the work herein described. This application s man tompiis ifance with County Ordinance No 5 49.. p 1 'i ' '! ` ---------•---•--- JOB ADDRESS,AND LOCAT �________ �- =-•A s Name_ !_L� - -- ----- ----------------------------- Owner �Phon'edµ+ - _ - ! _ 12__Z-�---�,_. --------•------------------------------•-••------•-------- •----•---•------- ----•- Address...--------• ---------- ---------------- --------------•-------------•-----------••------ ---.-. Phone--- = -------------- Contractor's Name-- ----------- ----•-------------.-------------- ---------- ------------ -----•------- --------------•-------------- - � ------------------ 1. •--••,---. --- ` Installation will serve: ResidenceApartment House ❑' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ____ umber of bedrooms ._1--- Number of baths ____ Lot size --------------_------_-.--- _-----•--------------•• ------ a Water Supply: Public system ✓8 -Colmmunity system ❑ Private ❑ Depth to Water Table Character f soil to a depth of 3 feet: Sand F1 •Gravel E] Sandy Loam El Clay Loam El Clay ❑ Adobe Hardpan I-] Previous Application Made: Yes E] Na [. `�New Con struction: Yes [ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _ *� (No septic tank or`cesspool permitted if public sewer is available within 280 feet) Ler >� % I -.-.:_._- ---- --- Sept - Septic 'ank: Distance from nearest well-r�_• __-_.-`Distance fro -fou ion _ No. of compartments....--...-4------ Size--I Liquid depth---- ---- f------- Capacity..- - _ Distance from fours �_ _j � Distance to nearest lot Ii � ~ Disposal Field: Distance from nearest well r �. datio - - ®� Number of lines--- . ....qt�_-- ---___-- Length of each'line-_- ____- -----.Width of trench------Z --_i' _------------ De th of filter mater3aL-------- ---------Total length------•.------V - ----------------- Type of filter materi -. -1� p Seepage Pit: . Distance to nearest well------- -__---_Distance from foundation-------------------.Distance to nearest lot line--------------------- ! ❑ Number of pi - ts------- ---------- -Lining material-----------------------Size: Diameter-----------------------Depth----------------------------- Cesspool: Distance from nearest well------------------- from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------- Liquid Capacity gals. CA Privy: Distance from nearest well-------------------------------..----------------.-Distance from nearest building---_------.--__--------------------------- ❑ Distance to nearest lot lire=---------------- ------ ------------------------------------ Remodeling and/or repairing (describe)s---------------- ----•------------------------•--------------------.-------=----------- ------------ -- -------------------------------- -------------- --•----------------•------------------------•--------- -------------------------------- -------------------------------------------------------•------------ ---- -------------------------------------------------------I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin oun+ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned -------------- ---------------------------------- ---------------------- --------(Owner and/or Contractor) or� g �f!_,.�. �--•'-�---------=------------------------------------------------------(Title) - Y= (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-1A�--------------- REVIEWED BY ---------=------------------------- ------------------------ ---------------------- DATE_ f -..-...--------------------------•-------- �-------------- ------------------...--------- I BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE . - ' 1 l f. -Alteratonsrd/or recomme datio s:------------- ----- ----- ------------------ - r/- u. � ------------------- --- -- ------ ------ ---------------------------•---------•----- ----..._S - rr Y ----- ------ -•--- --------------- -77 - -- - - --- -- -------------------------------------- --------------•--- FINAL INSPECTION-BY:._ (� ------ --------- -=-------- ' Dale-- --` - - --•- ---- SAN JOAQUIN LOCAL HEALTH bISTRI T 130 South American Street 300 West Oak Street3�11 –•`132 Sycamore Street $14 North "C" Straet Stockton, California Lodi, California �.,Manteca,,California Tracy, California ES-9--2M Revised 1.57 F.P.CO.