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APPLICATION FOR SANITATION PERMIT Permit No. Z�S ��,.`�* ell r x (Complete in Duplicate) Date Issued _f��-,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 OCAT O --- l ----- ®` dl,079/'----•------------------------------------------•-------------------- Owner's Name----- 1 ---- - - - ------------------------ - ------------- ------------------------------------ Phone--------------- ----..- ----- Address------------------ZJ41. r - --------------------------------------- Contractor's Name--------------- - - ---------------- Phone----------------------------------- ---------------------------------------------------- Installation will serve: Residence E] Apartment House E] Commercial Trailer Court E] Motel Ll Other F-1 Number of living units: _"R'__- Number of bedrooms ___` Number of baths --_- Lot size ___l . Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8--lHardpan [] Previous Application Made: Yes ❑ No RTO� New Construction: Yes ❑ No R'_PHA/VA: Yes ❑ No 0--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) epti Tank: Distance from nearest well_________________Distance from foundation--------------------Material _____.______- ------------------------No. of compartments-------------------------Size-.------------------ -----------Liquid depth--------------------------Capacity--------------Jf - --•-- i Disposal Field- Distance from nearest well----"-"-_.Distance from foundation____ l ,p____.__Distance to nearest lot line___��---�- ' i Number of lines__________ __ _____ _ Length of each line__ _ ff�� -e��'---------------Width of french..... ,��f-b------------ ---- Type of filter material-l-'�4VVdDepth of filter maferial_____ _-----Total s � . 5 page Pit Distance to nearest well-------:�''____-__Qistance from f undation___-�Q_______-Distance to nearest lot line___2_7--____ ,' � Number of pits_______r______-____Lining material_ ____Size: Diameter____fid. p / � Ce pool: Distance from nearest well-----------------Distance from foundation---------------------Lining material-------------------------------------- \t i F1r . Size: Diameter------------------------ -------------Depth----------------------------------------------------Liquid Capacity------------ -------gals. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ I ❑ Distance to nearest loft line ---------------------------- ----------- Re odeling and/or _____________ _ rv� t r ______________----------------------_____----------------------------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and reguiat'ons of the San Joaquin Local Health District. (Signed) �I - �+ r Contract Or) By:__-----------------------•------------ -- " (Title)- - ---------------------------- (Plot plan, showing size of lot, locatf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------------------------------------------ ------------------------------------------------------ DATE-------------- -------------------------- REVIEWED BY-----------------•--------------------------------- -- -------------- DATE-------ZZ BUILDING PERMIT ISSUED--------------------------- ------------------------------- ---------------- DATE------------------- --------------------- --- - ------------- Alterations and/or recommendations---------=---------------- ------------------------------ -------------------------------------------------------•-----••----•---------------------------------------------•------------------------------ ------------------------- ----------------------- ------------------------------------------------------------- l.� _ FINAL INSPECTION BY:. -------------------------------- Date -L - I ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North ••C•• Street Stockton, California Lodi, California Manfeca, California Tracy, California f ES-9-2M , Revised 1-57 F.P.CO.