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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicafe) Date Issued Application is hereby made to the San Joaquin ocal Ith ist a permit to construct and-install the work herein describe This application is made in compliance with Co my O - �� JOB ADDRESS AN,PpLOCATION. �� r " �` ------- Owner's Name----� �---•- � - -------------- ,. ----------------------------------------- Phone------ ---- ----- --- �c r ------ ----------- Address ---------------•---- = Contractor's Name---------------------+ !'lF ✓`------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ ; Number of living units: __T"__ Number of bedrooms___ Number of baths ___/_ Lot size =. - ---- -- --, - ----------------- Water Supply: Public system ❑ Community system ❑ Privatl�< Depth to Water Tabler;[7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoA New Construction: Yes j& No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) � � -Se ti Tank: distance from nearest __ 0- --DistafndatirL � dLNo. of compartments--- Size__ ` Liquid pth__ r _ Capacity. 10_Q - l Disposal Field: Distance from nearest well__c,�_____Distance from foundation---r ____-----Distance to nearest lot lin ___ - _ _ _ - p Number of lines---------- ____ ----- Length of each line---------- ........Width of french __'2f�_"7_____ --------- _r Type of filter material__ _T__ Depth of filter material---,/:Total length-------- "----- Seepage Pit: Distance to nearest well.__ _d I___ ___Distance f om fo dation____, -_. D)stance to nearest I t line-- Number of pits_-_-_-_-__1----------Lining materialize: Diameter_?_,J( V____.Depth___k1_____________________ yl ! Cesspool: Distance from nearest well------------------Distance fro foundation--------------------Lining material---------------------__ ❑ . . Size: Diameter--------------------------------------Depth-:---------------------------- -------------------.-Liquid Capacity-----------------------------gals. ` Privy: Distance from nearest well------------------------------------------------- from nearest building______________-_____________________-_-_. ❑ Distance to nearest lot line-=--.-•--------- ------- -------------=------------- -----------------------------•------------------------------------------------------------ _. � r � 0fl,� / r Remodeling and/or repairing (describe):---- rD ---,rl��"`'�'L - -•---/~ XX --------- ------ --------------------------•--•--------------------- --•-------------------------------------------------•----------------------------------- -------------------------- --------------------------------------- ------------------------------------------------------------------•---------------------------------------_------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, fate laws, a d rules Apd regulations of the San Joaquin Local Health District. Signed ------------------------------------- ---- ------------------{Owner and/or Contractor) . By:--_-----------------•------------------------------------------------------------------------------------------------------------(Title)------------------------------------------------------------ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY--------- DATE------ REVIEWED BY ------ ---=--- - --------- DATE ---------7---- �� BUILDINGPERMIT ISSUED------------------------- ----�--- ---- --------- ---- ----- --- -- - ------------------ DATE-- ---------------------------------- ---------- -------- -- Alterations and/or commendations'---- - -------- ------------------ ---- --• V-41 , alm -----Z ----------:-'�- ----- �t"'•- ------------------ ----- -- - - -------- -- -------------- -------- --- ----- - FINALINSPECTION BY--------------------------------------------- ------------------- Date------------------------------------------------------------------------------- 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-4—•2M Revised 1-57 U.CO.