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APPLICATION FOR SANITATION PERMIT Permit No. -_1z_l-_______.__ (Complete in Duplicate) gg Date issued 77777= Application is hereby'made to the San Joaquin Local Health District for a permit to construct and.insfall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA ON_ - - - ------------------------- ' Owners Name----- = __ =r- = ------------ -- Phone----•-- =------------•--•-------- •- -------- -------- t . / �e Address [P_3.0- ------- --- �----------- ----- Contractor's Name---- ----• � � "." r" �' Phone --- Installation will serve:1 Residence Apartment.House El—Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /Number of bedrooms __ Number of baths __ ____kLot size ___ ._ U a-------------------------- 9 w r Water Supply: Public..system r�"�Commun'ity system ❑ � Private ❑ Depth to'Water Table S7 ft.— Character of soil to a�depfh f 3 feet: Sand ❑t Gravel ❑ Sandy Loam ❑_ Cla Loam ❑ Clay ❑ Adobe Hardpan ❑ , j Previous Application Made: Yes ❑ No New Construction: Yes ❑ o FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPEC (CATIONS: - - (No septic tank or cesspool permlfted if public sewer is available within 200 feet.) . IS c T nk: Distance from nearest weN_________________Distance from foundation___________-_____.Material_____.____-_____________________.______- No".of coin artments-------------------------Size---___:-_-_------- Liquid depth------------- ---- Capacity fsposal Field Distance-from,nearest,well1_,vkjP ,._Distance from foundation_,/6?_-- Distance to nearest lot line_��_. ____ Nk mber of_lines___._,: _____.____ '-Length of each yline-,-___-_.7.5=_?___'1-_��.Wid#h of trench._____.7___ __-----;__._.______- Type of filter material- _,Se _. -. .-._.Depth of filter maferial-------- ______Total length______��_____________________________ Seepage�Pit: Distance #o nearest well y`bistane6 ro fos�ridetion____ '._..:_;Distance to nearest lot line`__,______ Number of pits-------- _ Lining material_._ . _.Size: Diameter___---- Depth_____.,_____.Depth_cR__ --------------------- Cesspool- _______________ L Cesspool: Distance from nearest well----------------Distance from foundation------------- Lining material__.__________-_.________-___________ t ' _ Liquid Capacity gals. ❑ Size: Diameter----- ----- - =------------Depth----------=------------=-----:-----• 9 P Y;------=-- Privy: Distance from nearest well----- ---------.---..-_____._____________.______Distance from nearest building'__.___________________-____-___.___. ❑ Distance'to nearest lot line--------------------- ------------------!,n --- .. ---- ----------------------------------- Remodeling and repairing [describeJ: =--------- ---•-•------`-----------------------------------------------------•--------------._-.-_.--------------- ---------------------------------•--------•---------------------••------------------------------------------•------------------------------------------------------------------------=---•---------------------------------- f T '-Tf --------------------------------- --'>------------------------------------------- ----------------- ------------------------------------•-------------------------------------------------------------------------------- I hereby certify+hat,41 have-prepered this application and that'the work will be done'in accordance with San Joaquin County ordinances, Sfate a s, an rules jonionsregulatof the San Joaquin Local Health District. (Signed)------ ----------- 1 Owner and/or Contractor By:---------------- ---------------- --------------------- ------(Title)--- ----=------------------- --------=---------- (Piot plan, showing-size of lot, Iota+ion of system in relati to wells, buildings, etc., can be place n reverse side). e FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_ --------------------•-------------------------------..-.. DAT --------- -------------------------------------------- REVIEWED BY------------------------- DATE -- ---- ------------------------------------------------------------------- --- ----------------- rBUILDING PERMIT ISSUED-------------------------- ------- ' •--------------------------------------------------- --------- DATE---�i----------=-,----:--=------------------------------- Alterations and/or recommendations:mmendations:----------------------- --- ------------- ------------------------------------------------•-------•---------------`-------------- ------------------------ / = L a ---------- ? li4 ------------ Qov ------ `�r� ' � m�a .y ?-!'� .... .. ---------- i p -f. . FINAL INSPECTION BY:.-- ---;7300 -`/!.C�t_::----W'----= = ---� Date-...-----:-_------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revise6 1-57 F.P.CO_ " j