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APPLICATION FOR SANITATION PERMIT" Permit No. (Complete in Duplicate) ��•- Date Issued .____/:�.__�� Application is hereby made to the San Joaquin Local Health District for a permit to c. nstru d instep— This application is made in compliance •th County Ordinance No. 549. E-� e"work herein described. --------------- JOB ADDRESS AND LOCATION______ Owner's Name--------- ...... -------- ---- -- �j -- - ------- --- Address s -Gr1 dPhone/- _ Contractor's Name____ Installation will serve: Residence o Phone Apartment House ❑ Commercial Number of living units: __----_ Number of bedrooms ---_-_-_ ❑ Trailer rrCa�rt ❑ Motel ❑ Other [�6769pt Number of bathsp�__��_i'LDt size ___ -��' Water Supply: Public system --- Pp y' Y ❑ Communit system -�'�-�"----�---- Y Y ❑ Priya fie X Depth to Water Table&d__ ft. y� + Character of soil to a depth of 3 feet: Sand ,[Gravel ❑ Sandy Loam Clay Loam � Previous Application Made: Yes No Y ❑ Clay [] Adobe❑ Hardpan ❑ ❑ New Construction: Yes .No Ej FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T k Distance from nearest well — --Distance from foundation__-�D - No. of compartments _-" �-- - Material______'__--_--_��f' Size , 5__�- _ Liquid depth---- ��--------- Capacrty Disposal `eld: Distance from nearest well___S -�_-_Distance from foundation--C,_ Number of lin es_ � Length of each line-- Seepage ine____ tJ _ "Distance to nearest lot line___--__-__- Type of filter materia!__. / , --- Width of french---o�5/_'� --'1-l�C __Depth of filter material___. �- See a e Pit: ___Total length_____-_-�QQ -- -------------- p g --------- Distance to nearest well--------------- _Distance from foundation--------------------Distance to nearest lot line__-_ Number of pits----------------------Lining material-----------------------Size: Diameter_---------- ---- ----.Depth--------------------------------- Cesspool: ---- �----- Distance from nearest well__---_--_---_-_Distance from foundation---.____---.____-Lining material------------------_-__ O Size: Diameter-- ------ - --- --------Depth-------- --- ---- ----- - -------- -- ----------------Liquid Capacity--------------------- -gals. Privy: Distance from nearest well------------------- } -------"____--__._Distance from nearest building ~! ❑ Distance to nearest lot iineg---------------------------------____-_. ------------------------------ -- ------------------- Remodeling and/or repairing (describe):_____________________------------------------------------------ ----------- --•--------•-------------------------------------------------------•--------------------------------------- ------------------------- ---------•--------------------------------------------------------------------------------------------------------------------------------------•------------------------------ --------- I hereby c INN that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St t laws, d ule a d regulations of the San Joaquin Local Health District. (Signed- --------------------------- -- -- ------- ----- - gy; s (Owner and/or Contract (Plot plan, showing size ot, to of system in rhe a`fi�rr to wells bui (Tills]__.-__ -_ .............. / or) -- ----------------- dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - ------------------------------------------------------------------- DATE- 7 REVIEWED BY ................................... --------------"-------- ------. . ... BUILDING PERMIT ISSUED-------- --------------------------- DATE-- ------------------------------------------------------------------- and/or recommendations:--------- ------------- DATE--_----- ---------------------- _. ----------- -----------------------------------------------------------------------------------•- • ---------------------------------------------- ---------------------------------------- ----- ------------------------------------------------------------ -------------- FINAL INSPECTION BY:._�_ _-- ---- -- - --• ------- ------- ----•--- -------• _ --- - Date. - ---- .-2-Y--- ---1-��- ------------- SAN JOAQUIN LOCAL HEALTH DISTR . 130 South American Street 300 West Oak Street Stoek+ort, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California E5-9-2M Revises 1-57 F.P.CO.