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4��4 S- -� APPLICATION FOR SANITATION PERMIT Permit No. ...__. �C. L' (Complete in Duplicate) Date Issued ______ l Application hereby made to the San Joaquin Local Health District for a permit to construct a inst he work herein described. This application is made in compliance with County Ordinance No. 549. Al—ICE, JOB ADDRESS AND LOCATION--- (, �_... ------- ev 1-11 ----------------- Owner's Name-- --- ... c''."-.........------------------------------------------------------------ ------------ Phone------------------------------------ Address------------oil✓-- - • ------- .1 -------------- ... •••- Contractor's Name--- ------• -•--•7 -- �`'14-c/------------------------------------------------- Phone 1 C�- ` Installation will serve: Residence fi Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _ __ Number of baths ---I--- Lot size ----k7_?__ s _ ___________________________ Water Supply: Public system [4 Community system ❑ Private ❑ Depth to Water Table 0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ 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.) Septic Tank: Distance from nearest we1l_:n4Af____Distance from foundation-_-_!-_1•-_____.Material___ _________________ 1 No. of compartments___ -----------------Size____3,X_5� ..I.......Liquid depth-----�''---------------Capacity.._$fd_�_ Disposal Field: Distance from nearest well:7=-------Distance from foundation- '9_---____-.Distance to nearest lot line-4----.___® Number of lines__--__.__�-----------------------Length of each line------- --- __.-.____..Width of trench--- �:`--_______-.________-___ Type of filter material----Jl�______Depth of filter material__,______________ 9_c� Total length.... ...._._____.___.___._.__...____ S k r 0i r t: Distance to nearest II____-________________Distance from foundation_. .__.______._.Distance to nearest lot line____.________-_- r�\ ( Number of pits______ 1.__._____Lining material----Fak'_�'______Size: Diameter.__'+' C---- Depth______.__LP_.P_______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-_--___---_----._-___---___-______ ,❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line-------------------------------------------------------------------•--------------•-------------------------------------------------------- Remodelin and/or repairing describe -----------------------•-------•-•---------------•---------------•-=-----------------------------•-------------------------------------------------------------- - ----------------------------------------------------------------------------------- ----------------------------------------•----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (� (, (Signed)_- ---1 ___.C. __.________ _ 11.... _�f C` _________Owner and/or Contractor ( / ) ----- ---- ------------------------------------------------------------- Title ? ------------------------------ (Plot 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 ?REVIEWLD BY----------------------------------------------- ----------------------------------------------- DATE---- --••- ------ ----- BUILDING PERMIT ISSUED----------------------------- - ------ DATE--- ---------------------- --------------- -------------- Ato ations and/or recommendations---------- - ---------------------------------------------------------------------------------------------------------------------------------------•-------- b �1A�57 --------------------- --- ------------- --------- ----- -- CIO -�h- __--- ..___-..__-__ -------------------•----_..._..._.....••-.-.••- -------------------------------------___-________._________:__---___.__._-__-___.-_-____._---_-.._-.-_•-.__---_._.-__-_____-__---_.__._-..-___..___-___-_____-____-____--_-__.-___-__--_-._______-_- ---------- FINAL INSPECTION BY:. --------------------------------- Date z3-- ----------------`� 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-9-2M Revised 1.57 F.P.CO.