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N �APPLICATIOWFOR SANITATION. PERMIT Permit No. ..l..�S?._. _... (Complete in Duplicate) y y = Date Issued Application is hereby made to the San Joaquin Local Health District for a per it to construct and instal4 the work herein described. This application is made in compliance with County Ordina ce No. 549 JOB ADDRESS AND , CATION------ �f______.__ ------ --- --------- ---- - ----AOwner's Name.------- - • - =-=------------ - --------- ------------------------------- Phone _. ,Gt_ ----- Address----------- ddress----------- --- --------- - - - •-------- -----------------------------...-._------•-•---------------------- --------------- ----------------------- Contractor's Name---------------- - a ------------------------------------------------------------------ Phone ,A,— f� Installation will serve: Resi ence [xj,'Apartment.House E__Commercial.❑—Trailer-Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms __lumber of baths --/ Lot size ---------_- _ /d ______________________ e Water Supply. Public system �ommuni y system ❑ Private ❑ Depth to Water Table- ft. ", , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay.E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction Ayes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if �urWricer is available within 200feet.�,s.Septic Ta Distance from nearest well "--- stance from foundation- -------Mater�l_-_______ No. of compartments----- ;I-------- --.S- e___�__�� _L__----Liquid depth----- Disposal Id: Distance from neares well-9, ?stance frori-i foundation--1';-;0--1--1r.------Distance to nearest lot line--- -----5� ER Number of lines------- ---_. Length of each,line__-___ 4 �" r� €-: .Width of trench -- Type of filter material___+.'_ _Depth_of filter material______, ��_____Total length________________________��___-.._ Seepag it: Distance to nearest well_ __ ___ Distance m f ndation____ �, stances to nearest lot line_ _.., -- Q----- IF Number of pits - Lining material -size: Diameter_ Depth Cesspool: Distance from nearest welt_________________Distance from foundation------------- .____-Lining material__-_._____.___-__-_--___-_______.____. ❑ Y Size:^Diameter-------------------`:_-- ------Depth---- I-------------==------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well---------- :-_—. -------#'_------_- Distance'frvrri'nearest building----------------------------------------- ❑ Distance to nearest lot line -- --- - ,..y.._� _... - }------------------------------------- >.--- = Remodeling and/or repairing (describe):. '`--- - _ •----------------------------------------------------------------------------------- ------•----------•----"--------------------------------------------------•---••-------------------•-------- ---------------------------------------------------------------------------------• -------- ----------------------------------------------=--------•=----•--------------------------------•-------------•--=-----------------------------------------•--------•-•--------------------------------------------------------- I here'y e afy that I ev prepared this application and that the work-will be done in accordance with San Joaquin County ordinances St to I w n rul s and r�gul ions of t San Joaquin Local Health District. -__ "","._[__" Owner and/or Contractor (Signed)-------- -- ----- .bac °:u ,; { / - - ------------------------------- - --- - �� LTi+lel (Plot plan, showing size of lot. Iota on of system in rela+ion to ti buildings, efc., can be placed on reverse side). ; FOR DEPARENT USE ONLY APPLICATION ACCEPTED B I -- DATE- "----------------- REVIEWEDBY --------------------•---------------------- DATE- -- ---"--------------------------------------•------- - BUILDINGPERMIT ISSUED---------- -----------------------I------------------------• .t------------------------------------- DATE------ Alterations and/or recommen'dations-------------------------------------------------r„---------------------------------._...---------•--------- ------------------------------------------------ I , _________.______________________________________________________________________________________________________._-______-___.____.__--________-___________:_.___---____-_-__________________.___________________________-_ ---------------------------------------------------------------.---------------------------------------------.--------------------------------------------------------------------------------------- --------------------- _____________________________�._____________.___________.__--____________.._�_.__.____________._^..___-_-______.---- -D--a--t-e-----------.________-___.____-,_,.________...____ ___-._______._____.__.___. -------- 4 �".�"5 FINAL INSPECTION BY..---� _ -=---�------/----- -----------=------------ ----- ---------------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT - 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 Devised 1-57 F.P.CO.