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APPLICATION FOR SANITATION PERMIT er�mit ;No.. Z (Complete in Duplicate) / � D e Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in al'. he rk herein described. This application is made in compliance with County Ordinance No. 549. p JOB ADDRESS AND LOCATION------------------------------------------------------I—----------- -- ------ ---------4, Owner's Name_______ __=_S - Ph ne--_ ._ �. Address--------------------- -------�..-------- - - - ----------------------------------------------------------------------------•-•-••---•-------•---.._..... --------- ------------ - Contractor's Name----------- Ne"------- --- s--`-77------_�_ ----------------------------------------- Phone- --- r ,`1 . Installation will serve: Residence EApartment House Commercial E] Trailer Court E] Motel ❑ O er Number of living units: ___-____ Number of bedrooms Number of baths `____ Lot size __-_._.� s r------------------ --- - Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table,3_J__ ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El"Hardpan'[]` Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: .c.$,..' (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic k: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. _-----_ --_____-..____________________----__--.No. of compartmenhs-- ------Size-- _--------------------------Liquid depth--------------------------Capacity----------------------- posal Field: Distance from nearest well----------- -----Distance from foundation-------------------.Distance to nearest lot line----------------- Number ------ __-____.Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material-------------------- ----Depth of filter material-----------------------Total length-------------------------------_---------- r f Seepage Pit: Distance to nearest well_�0y_1�_----Distance om foundation___fd_.--.___.Distance to nearest lot line__________ Number of pits-----/-------------Lining material_ !Size: Diameter-------__ .�- Depi-ir----- �-�---- 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_____-________-__________-___._____-._. ❑ Distance to nearest lot-line---- --- --------- --------- ---------------- --------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)___ __________________ �`� - ---------------------------------------------------•------------------•------------------------------------------------------------------------------------------------------------•--------------------------------------- -------- ------- -----------------•----------------------------- -- j ------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------•------------------------------------•----- I hereby certif that I have prepared this app cation and that the work will be done in accordance with San Joaquin County . , ordinances, St a w,, and ru es and regulatio Kof the San Joaquin Local h District. (Signed)----- { `' r Contractor -- ----- -------------------------------------------- Titlecf .� (Plot plan, showing size of lot, location of Sys m in relation to well buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------ ------ - ------------ ------------------------------------- - DATE----- REVIEWEDBY----------------------------------------------------- ------ --------------------- -------------------------------------- DATE_.- i BUILDING PERMIT ISSUE ---------------------------------------- ----------------------------------------------------------- DATE---------------------- -{ ------------------------ --- - -- ------------ Alterations and/or reco :--------=-- -----------------------------------------------------------------------------•---�--•-----i3 ----------•--•• ---- ----------------------------------------------------------------------------•--------------------------------------------------------------- -----------•_--------------------------------------•---------------•------- FINAL INSPECTION BY:--- ------------------------------------- Date---- �`�1 ------- --------=--------------------- 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 , Revises 1.57 F.P.CO.