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APPLICATION FOR SANITATION PERMIT Permit Na. P, (K�� ., (Complete in Duplicate) q Date Issued ._ Application is hereby made o the San Joa um Local Health District for a permit to construct and install the work herein described. his application is made m co Bance with County Ordinance No. 549. O _2� JOB AIDDR ESS AND LOC TION____ �j Owner's Name___. " - ------------------------ P� Address '/ Phone ---------------- ---------------- --------------------- Contractor's Name---- ---•---- --•-------••--•--•------•-- - - --------- -- ------- Installation will serve: Residencep Phone--------------- --•--- Pll'A artment House ❑ Commercial ❑ Trailer Court l Number of livingunits: __�" ❑ Motel ❑ Other ❑ Number of bedrooms _ Number of baths .A, Lot size Water Supply: Public system - --- -------- Y ❑ Communit system Y Y Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam f�'Cla Previous Application Made: Yes No Y ❑ Adobe ❑ Hardpan ❑ ❑ � New Construction: Yes B"-No ❑ FHA/VA: Yes [ No ❑ TYPE OF INSTALLATIONAND SPECIFICATIONS: s W (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) CY Septic Tank: Distance from nearest wG4-_)74-?x-_-LDisfance•from foundation-------------------- -""��"� ? No. of compartments..""_�.-_ --- ------.Ma Material CP: --- ------ -Size-��_�_�_s�.---Liquid depth_--��-' Disposal field: Distance from nearest well Ca pa city.-_ Distance from foundation .4 1 to nearest lot line__-" ""�" Number of lines :;;'------"",,,*Length of each line_ __�(�---------------Width of trench-----Z_�!! Type of filter material/ ----�-_j �, �n Depth of filter material- "-- -Total length______--�--— ------------------- Number -- Seepage Pit: Distance f nearest well________________----Distance from foundation--------------------Distance to nearest lot fine__- _____---- ❑ Number of pits----------------"-_---Lining material-""__-------------- ----------Size: Diameter------------------. -- Depth-------------------------------- -----------------Cess ool; r - ❑p Distance from nearest wellDistance from foundation------------------- Lining material-______-______ 1 Size: Diameter-------- - ---Depth -- -------------- --------------Liquid Capacity----------- Privy: Distance from nearest well_- ___._--"------_-_ ---------------gals. -------------____________"Distance from nearest buildin -� ❑ Distance to nearest iot line--------------- g i ------------------------------------------------------------ Remodeling and/or repairing (describe):----------- ------------------------ ---------------------------------------- -------- / a ----------------- -------------------------=------------- ------•----------------------------•-----------------------------------------------------------•-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- i ---------------------------------------------------- ------------------•------------------ { n r Cantractorj " ----------------------- - (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., canbeplace`d on rreeve esid---------------------- size ' s - --------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ---------------------------------------------------- REVIEWED BY------------------------ ---------- BUILDING PERMIT ISSUED----- "-- DATE_=_ -------------------------------------------------------------------------------------- DATE-- Alterations and/or recd mend ions_ ____________ __ ___ - -- _ . - �--------- __ -------------------- --- _ ------- ----- � -------- "" - - FINAL INSPECTION BY:_____._ eLAJ----------- ---------------=--- Date_ or -- f-- ----- ��-. 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 Revised 1.97 E.p.CO.