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r� APPLICATION FOR SANITATION PERMIT Permit No. ____ _G__ _ ` (Complete in Duplicate) Date Issued --- , A plication 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. ! a� }. JOB ADDRESS AND LOCATION ----------------- -------------- kOwner's Name (�(� • - ------- . ----- ---------------------- Phone------------------------------. --- Address -------------------- •- -------- ---------- ----------------------------•---------------------------------------------------------------••------ 1 � s Contractors Name Y -- -•---- Phone .. Installation will serve: Residence B"- partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ o ' Number of living units: ---3-- Number of bedrooms __ - .a'S--Q-1--------------- Number of baths _______. Lot size ______________ _ Water Supply: Public system 9?11-Community system ❑ Private ❑ Depth to Water Table S4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ tj 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.) e ic-T.*k: Distance from nearest well_________________Distance from foundation--------------------Material______._______._______.__________._.____________- 1 No. of compartments---------------------------Size----_------ Liquid depth--------------- -- Capacity po . Fie Distance from nearest well.:_Distance from foundation___' ""r ___.Distance to nearest lot line____. Number of lines----------------------------------Length of each line------------------------------Width oftrench---------------------------•------- i Type of filter material--------------------------Depth of filter material_,--------------------Total length.-___-_-__-.__-____-_______________-_____ Seepage Pit: Distance to nearest wa%/0.Q- .......Distanc om fqundation__/I..r._____-Dista is to nearest lq iine�Q__"_-.. Number of pits_________________Lining material_ ±_ / _--Size: Diameter---� ---_-------Depth---,A6-s-5 V Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-___ _ _ _ ------- 1 ❑ Size: Diameter, '---------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: . Distance from nearest well-------------------------------------------------Distance from nearest building_________-__-____-___-_-__-._-.____._- O ❑ Distance to nearest lot line-=-----=------------------------------------------------------------ ----------------------------------------------------------------- Remodeling and/or repairing (describe}------------------------------------------------- -----------------------------------------------I------- ------------------•------------------------------------------------------•-------------=----------•---------•--------------------------------------------------------------------------------------- -------------------- ----------------------------------------------•---------------•-----=--------------------------------- ._----------•---------------------.--------------=--.--------------------------------------------------------------- ----------------------------------- ---------------------------------------------------------•--------------------------------------------------------------------------•-----------•-.------------------------------- 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and r es and gulations of the San Joaquin Local Health District. } I _,__1(S19 ------------ ------------ wner and/or Contractor) ned) ---- -- ---------------------------- 97 - ----- Title -------- ------------------------------ (Title) t (Plot plan, showing size of lot, location of system in relation to 411s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------- --- - - ------ -------------------------------------------------- DATE-----!5- ------------------------•------------------------ REVIEWED BY - ---------------------- --------------------=----- DATE- BUILDING PERMIT ISSUED------•---------------------- DATE Alterations and/or recommendations:-•-----=----— ---------- --y-------------------------------------------------------- __. ------------- ----- j --- ------------------------------------------- ......._- ------ ---------------- - --- - 1 :r.. ` �� •---------------------------•--------------- -------------------------------- ------------------------------------------------- ---------------- ------------------ -------- -------------------- ------------- ----------------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------•-•-•---•-------------- 6�vz------------FINALINSPECTION- BY:----- -------------------- _------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 3Sycemore Street 814 North "C" Street Stockton, California r-_ Lodi, California IV14feca, California Tracy, California / ES-9-2M Revised 1-57 F-P.CO.