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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 construct and install the work herein described. This applicatio is made in compliance with County Ordinance No. 549.,E ; 045 23rS4f,Sa. JOB ADDRESS AND LOCpATION-- -----------------------"" {7 'r '.� ----- ---- Owner's Name-V_!lT Phone ---------------------------------- ------------------------------------------- Address---40--�--- -- -------------------------------------------------------------------------------------------------------------•------------- -++ :I, .1 �/� L ; � Contractor's Name�cr�---------------------------------------------- Phone .------------------------------� , Installation will •serve: Residence IR Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Numbeillof living units: --- Number of bedrooms --_----- Number of baths A---_ Lot size----�-�.,k,__�„3.�---------------------------- � k HH i1 ! Water Supply' � Public system ❑ Community system ❑ Private IX Depth to Water Tabl,gS-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam R Clay ❑ Adobe ❑ Hardpan ❑ II: Previous Appli Nation Made: Yes F]No New Construction.: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No seplic,tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: I' Distance from nearest well -%C -AP -.------.Dista e from foundation-- - e�P--•------.Material_- -- No. of compartmonts----- -- -- -------------Size-- 3�-r------------Liquid de th__-_ - _- -------- Disposal Field:' ; Distance from nearest well__b#------- -- Distance from foundation ---- ID ---------.Distance to nearest lot line ---T ----------- 1 J Number of lines ---------- I-------------- Length of each line____-��__- ------______.Width of trench. --2--+l ---------------- -- --- -- Type of filter material.-- ------ Depth of filter material---_ I-" ----------- Total length --- ' i Seepage Pit: Distance to nearest well- ----------------- ---- Distance from foundation -------------------- Distance to nearest lot line _--_-_---_.-----_ ❑ Number of pits- --------------------- Lining material--------------------- -Size: Diameter----------------------- Dept h --------------------------------- 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 --------------------------------- -------------•---------------•----•-------------_-----------------•------------------- -------------------- �,T Remodeling and/or repairing (describe)- -------------------------------------------------- •--------------------------------------------- -----------------------•-------•------------------------ a --------------•-•-----------•-----------------------•---------------••---------------------------------------------•----•---------------------------------------------: ---------------------------- 3 -------------------------- $ ---------------------------- - -------------------------------------------------- --------------------------------------------•------------ ---------•--------------------------------`-------------- I hereby artily that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St�ajte laws, and rules and regulations of the San Joaquin Local Health District. (Signed'-- -- --------- 10-1�6 ---------------------------4 t " - -------------------------------------------------------------- _(Owner and/or Contractor] By: ---: ----- _ :.-------------- {Title} - = _" _= —` (Plot plan, shing 'is ze of lot, locat' syste in relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY APPLICATIONJ�ACCEPTED B ff�_ _ .et F w -- DATE �' --- -- REVIEWEDBY,,---------- -- -- -------------------------------- - -��--«------------------------------ -- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED ---------- ----------------------------------------------------------------------- DATE.. Alterations and%or recommendatio :-------------------------------------------------------------- - - - ------------------------------------------------------------- --------------------------1---- ----------- ---- -------------------- -------------------------------------------- '--.------.---------- ---•------------------ ------------------ FINAL INSPECTION BY: -------'!� �. ----------• - Date ---------------- -- - !I 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 E5 -9-2M , Revised 1-57 F.P.CO-