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APPLICATION FOR SANITATION PERMIT Permit No. .-f (Complete in Duplicate) /� Date issued _____�Z_�-7___ 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 with County Ordinance No. 549. .,� JOB ADDRESS AND LOCATION:- -!!7/%T70' -,(? � / - - l Owner's Name Z�fi -L_- ----------------------- Owner's - -- Phone-------------- Address---------- Contractor's Name�� r3-t -•-- ----------------- -- ------------=---- Phone-------------------•---•---------• ' f Installation will serve: Residence Ikj Apartment House ❑ Commercial ❑ Trailer;Court ❑ Motel ❑ Other ❑ Number of livingunits: I_. Number of bedrooms -7n- Number of baths f '"`-Lot size __' Water Supply: Public system ❑ Community system ❑ Private R1 Depth to Water Table,_a__ ft. Character of soil to a depth of 3 feet: Sand Gravel _ Sand "L'oam Cla Loam f � ❑ Y ❑� ' � y �❑� Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [:1 No (0 New Construction: Yes ® No [ FHA/VA: Yes ❑' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - I . ! (No septic tank or`cesspool permiffed.if public sewer is available within 200 feet.) - No- of compartments _�---____Size_-_�- from foundation�l�____.___-__.MaterialL'�"�'��---_-•-----y �__ Se tic Tank: Distance from nearest well--r;__.__-------Distan e / p P "y.Ef_-t- ---- Liquids.depth . �----------Capacity--1 --------- Disposal Field: Distance from nearest weft_4©,__---.Distance from foundationt_10----_----Distance to nearest lot line__�V__________ Do Number. it lines--.--___ti�__-�-moi__ ----____ ength of each line/q.q____ -_:_____Width of trench - - - -------------------- Type of filter materials' - '- A� Depth of filter materraL __:" ________Total length------/-4_ '_______ t Seepage Pit: Distance to nearest well-___________-________Distance from f.' r ' oundation___________________.Distance to nearest lot line________._______ ❑ Number of pits__ ----------------- Lining :aierial-------------- --------Sizer`Diameter--------- Depth - Cesspool: Distance from nearest we!!____--__- `___Distance from foundstion--------------------Lining material_______--_______________--___________. ❑ Size: Diameter__F_ ___. - - --' Depth ---r Liquid Capacity ----- --gals. Privy: Distance from.newest well---------------------------------------------__Distance from nearest building Distance to nearest lot line ________'---------------------------.-------------------------------___________-_ 4 Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------- - I - ------------------ ------- ---------------------------------------------=--•----------•-------------------•----------------------------------------------------------------------------------------------•1--------------------------------- + I hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Sfa aws, and rules and regulations of the San Joaquin Local Health District. (Signed)-•------- " --" -------- - -------------------------------------------------------------------(Owner and/or Contractor By:---------- ------ - I Tale (Plot plan, shows g size of lot, location of system in relation f wells, buildings, etc.;can be-placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �REVIEWDATE g~' ----------------------- ED BY '-------------------------------------- ----------------------•------------------------ DATE BUILDING PERMIT ISSUED------•----------'----------------------------------------------------------------------------------- DATE-------------------- Alterations and/or recommendations:---_-----._________________ _ ' -----------------------•------------------------------------------------------------------------------------•------•-------- ------------------------ ---------------------•----- ----------- ---------------------------------------------------__- - FINAL INSPECTION BY: Date OJT- ------------------------ 67 SAQUIN , LOCAL HEALTH DISTRICT 1 130 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 1.57 F.P.CO.