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r D APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ! Date Issued -----__//314_0 � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worker n described. This application is made in compliance ith County Ordinance No. 549. , J pIr JOB ADDRESS AND LOCATION--_ �o_ -_-- ,_ _ r� 'cr?.- i ` rJ ------------------ -------------- , Owner's Name_ - ' - .�--�--- ---- Phone L_ = Address---------------•------ -. __._ ---- Contractor's Name----'."----•-•------------------ ---- Phone......_...__.-.--•- Installation will serve: )Residence Ir Apartment House ❑ Commercial ❑ 1 ' Trailer Court [IMotel ❑ Other El Number of living units: Number.of bedrooms Number of baths __�._- Lot size ----_1 To't _ ----------------------------- Water Supply: Public system F1Commur'ity system ❑ Private Depth to Water Table'-,S� t� r Character of soil to a depth of 3 feet:"S nd ❑ Gravel ❑ Sandy Loam& Ciay Loarrr ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) , Septic-Tank: =Oistance-from�nearest•well-_ � _'Distance-from=foundation-_, =_�-- M.a};ial No. of compartments- _--.. i :Size---fes _ --' -----Liquid depth ----5t---- -- Capacity---- d� --e-, Disposal Field: Distance from nearest well 'N Distance from foundation_�¢._4_............Distance to nearest lot line__S_"±+t�-u` �"+�-4..._=__ .. Length of each line-_____ _ ` Number of lines________ r 9 `�-=�-- ;:------Width of trench-----'��------ •-------------- �:L1 Type of filter material--i,_A Ik----Depth of filter material----/-'_______.__Total length_______4Q___----_- • --------------- - Seepage Pit: Distance to nearest well------------_`:_ ._._Distance from foundation---- .....Distance to nearest lot line-------------- ' ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---- Depth------------ -- , { ------------------- a Cesspool: Distance from nearest well_________________Distance from foundation---__--____-.-.____.Lining material_._.___.______.__.__.___ -------- ❑ ._.:;. size: Diameter :w: „ ¢Depth - -----'--- --------- --- --- -------- ----- Liquid.Capacity---------------=__ ---- gals, Privy: Distance from nearest well----------------" __- _ .---_______. ._---------Distance from'nearest building_ ~ ❑ Distance to nearest lot line-----------T------- --------------------- - - .. -.4 ----------------•--------- --------. Remodeling and/or repairing « r ---- -------------------- --------------------------------------------------------- ---------•--------•-------•------------- I -----•--------------------------------------------------•----------------•---•-------------------------------- "------•--_-----•-------------------- -------------------------------•-----------------I----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ,4 ordinances, State laws, and rules and regulatioffs)of the San Joaquin Local Health District. (Signed)---------------------- ,, .� .,d'o- �'" - "' " -------------------- ------(Owner and/or Contractor) By:------ -------------- ---------------------------------------------(Title)-------------------------•----•---•--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). vim_ T. a r FOR DEPARTMIEW USE LY APPLICATION ACCEPTED BY ------- ------- DATE -•-. . -------------------=----------------------- REVIEWED BY-------------------------------------- --------------------- ' ----------------------------- DATE------ ---•- ----- L BUILDING PERMIT ISSUED--------------------------- -- ------------- -- ----------------------------------------------•------- DATE...... Alterations and/or recommendations:-------------- - ' - - ----- :----••--------------------------- ----- FINAL INSPECTION BY:-------- - Date -- _ = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycarh*re Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Revised 1.57 F.P.CO-