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--APPLICATION FOR SANITATION Prn<MIT Permit No...1� �/•--- (Complete in Duplicate) Date Issued 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 w'th County Ordinance No. 544. ti 621 ------------------------- - JOB ADDRESS AND LOCATION_ ---------------- -- ----- --� '-- -'""""--- ------------------------------- Owner's Owner s Name ---- - - - ------------ -y---•- ------- -------------- ------------ ----------------- -- ------ Phone ------------------------- ----- Address ---•---/ p ----- -�--- - -- --- --------------------•----------------------------------------------------------- ----------------------------------- ------- -- Phone___Contractor's Name______-__ _ ----------------------------------------------------------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Air I� Number of living units: -------- Number of bedrooms _______ Number of baths -------- Lot size---------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ji.2...K. Character of soil to a depth of 3 feet: Sand K Gravel ElSandy Loam ElClay Loam ElClay ❑ Adobe E] Hardpan El Previous Application Made: Yes ❑ No� New Construction: Yes X No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewpris available within 200 feet.) p Siz ante from foundation_ ,- Q _M rill____ _...______.___ -- --- Se tic Tank: No of compartmentst_wel� r��Q Ie_-,� - -- -- Liquid depth------- ----, r__Capacity__/ C Disposal Field: Distance from nearest well---- �"-- Distance from foundation_4f?_-_____Distance to nearest lot lin Length of each line_ Q_'b_0 -�_.Width of trench_______ -41 ------------- �. Number of lines_____,,`_----.. g 6- Type of filter material_ ��epth of filter material____$ ff___--_Total length______.____________________ _ Seeep`age Pit: 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 ------------------------------------- 13 Size: Diameter ------------------------- ------------Depth-------------- --------------=r_------------------Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well______________________ ----_--.__________-_--.-Distance from nearest building ----- .----____.____________ ❑ Distance to nearest lot line ---------------------------------- - ------------- Remodeling and/or repairing (describe): ----------------- ---------------------------------- ------------------- - - - - - - - - - - - - - - - - -------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, a*loca+ion dulations of the San Joaquin Local Health District. 5i ned (Owner and/or Contractor) OY= ---------------------- (Title) 1 (Plot plan, sh wing size osystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------- -- -------------------------- DATE ------------------------------------------------------------ DATEBY--------------------------------------------------------------- DATE f f BUILDING PERMIT ISSUED --------- ------------------- - DATE !/.. - Alterations and/or recommendations: ---------------------- .__.-------- -----------------------------------------------------------------------------=--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --- ----------------------------- q----------------------- FINAL INSPECTION BY------------------ --•------------------- ---- Date -----f--.- -- 130 South American Street Stockton, California ES -9-2M , Revises 1.57 F.P,CO. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California