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---•- _��-�� APPLICATION FOR SANITATION PERMIT Permit No. . cy (Complete in Duplicate) Date Issued _�tb oia_ 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. �! ,_g JOB ADDRESS AND LOCATION------ / ------lr11.1-------�--------— -------- � /� ---------- - --.-- ------------ n- Phon Owner's Name-------------- _--. .�------•- .d, _/_F3�_��__�-------- --------- ----- -------------------------------------- --- Address i —,.e � f� _ ------ Phone_.. .1 � Contractors Name--------- ' �•------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ ` Number of living units: _ "__ Number of bedrooms —:?- Number of baths - ,Z Lot size ______ ,j_`"-_- (----_-- _-.------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -x7-- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [:1 Clay Loam [3 Clay ❑ Adobe ` Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes ❑ Nox FHA/VA: Yes ❑ N01 TYPE OF INSTALLATION AND SPECIFICATIONS: R (No septic Tank or'cesspool permitted if pu lic sewer is available within 200 feet.) tic T. Ek"I Distance from nearest well--;w----. __Distance from foundation--------------------Material----.--------------------------__________-____- No. of compartments--------------------------Size--------------------------------Liquid ----- -- - - --------Size------------------------•-------Liquid depth--------------------------Capacity---•------------------ ` �d'----------Distance to nearest lot h� ----- isposa -_�.� ,_-_ ( Distance from nearest ell__ di7� "Distance from foundation__ � � Number of lines__ ._.' --------------..-Length of each line -----,f------Width of french.__ ' ,�--------------------- �� ' 9 Type of filter matenaL__��-----`Depth of filter materia!____._______ ..._Total len th______ epa 't: Distance to nearest wall____��lf9___-Distance from fouation___.- ____.-__.DistancePto nearest lot line 1 --.--.� jOW Number of pits.__---/------_'---Lining material----e� ------Size: Diameter_ .-___---.Depth----5ZC7-----------------_ Cesspool: Distance from nearest well-----------------Distance from foundation-_.__________..____.Lining material-------------------------------gals. ElSize: Diameter------------------------------ -------Depth--------------------------- --------------- --------Liquid Capacity---------------- Privy: Distance from nearest well______________ __Distance from nearest building---------______-_______-..______.._---._. ❑ Distance to nearest lot lire__ ---------------------------------------- ----------------------------------------------------------------- A 00 Remodeling and/or repairing (describe):----- ........ ' ------------------------ ----- --------------- ---- ----- ---- --- }/----- ----- •----------------------------------------------------- ---------------------n__C-----oun -- I hereby certify that have prepared this application and the work will be done in accordance with San Joaquin +y ordinances, State laws, and rule and regulatio film San Joaquin Local Health District. w • and/or Contractor) 5i ned ------ -------------------------- ----- ----- O ner ( 9 )-----•---------------• +; ----- ---------------------•------------------------------------- (Plot -- - tTi+le) ---------- By: e - (Plot plan, showing size of lot, location of system in.relation to wells, Idings, etc., can be placed on reverse side). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE i `� - ---------- --- - ------------------------------------------ REVIEWED BY----------------- --------------------------- ------------ ----------- ------------ -------------- - --------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------- -------- - - ---------------------------- - ---------------- DATE-------------------------------------------------------•--- Alterations and/or recommendations----------------------- -------------------------•------•----------------------------- -------------•------------------------------------------- r ---------------------------------------- ------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- -------- ------------------------ - --------------•-------•--------------------- -------- 'b--- FINAL INSPECTION BY:----- ----- Date r --------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-7-2M • Revised 1.57 t.P,CO.