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fA APPLICATION FOR SANITATION PERMIT Permit No. ... _ Q (Complete in Duplicate) Date Issued t�� lk Application is hereby made to the San Joaquin Local Health District for a permit to construct and instafl the work herein described. This application is made in compliance witch/County Ordin' ceNo. —549. JOB ADDRESS A CATIO !J_� ` -- -- - ---- -- - ................................. Owner's Name-- - ----- Phon � L . ` ? -3Address ---------;-- --- . -- -- --- ----- - ----- ----................ ----------- Contractor's Name------------___/�-----G --------- "__ _..._.... Phon . / . . <j.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel F] Other ❑ / // n ' Number of living units: ____X Number of bedrooms . ;- Number of baths .,l __ Lot size '._„! / !o..-. Water Supply: Public system ❑ Community system Private E]- Depth to Water Table .�* ft. Character of soil to a depth of 3 feet: Sand E] Gr vg el ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No XNew Construction: Yes ❑ No FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIRICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) pti nit: Distance from nearest well-----------------Distance from foundation--------------------Material. ....__-__ _...--_........................ No. of compartments------------ --•---------Size---•------•-------------•-•-----Liquid depth-------------------------------------------Capacity ------- ......... i al Field: Distance from nearest well-----------------Distance from foundation....................Distance.to nearest lot line................. Number of lines-------------.---------------------Length of each line-----------------------_------Width of trench................................... Type of filter material____f�_-_y�_,_-_ -____-Depth of filter material--.-_•___ ___________Total length_.__._ ___.-_..- Seepage Pi Distance to nearest wellMAX)----Distan m fo dation-. S .. to ce"o neatest lot�ine .!-......... \ Dl ' ' p� Number of pits ----------- fining material Size: Diameter Depth SS'..__ \ Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material----------__.------------------------ 171 ____-____-_._____----❑ Size: Diameter--------------- -------------•--Depth---------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well - --_ _ __________________ .__ _Distance from nearest building_--__ ❑ Distance to nearest lot line------------ - ---- -- - ------------------------------------- ------------- ----------•- Remodeling and/or repairing (describe):------_-'- --------------------------------•-----------------------------------------------------........................................................ --------------------------------------------------------------------=--------------------------------------------------------------------------------------------------•---------------------------------------------------- - ------------- -------------------------------------------------------------------------------------------------------•----------------------------------------------- ----- -----. - I hereby certify that I have pre Pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ulation of the San Joaquin Local Health District. (Signed) ----.� �'---''2 ----" ------------------------------ wner and/or Contractor) / r BY --------••-•'... t1' � 5/r� -------------(Title) �. 'n size f lot location of stem in ation to wells buildin s etc. can be laced on reverse side). (Plot plan, showing s e o ry g , p ) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- - ---- ------------------------------------------------------------------------------------- DATE-=------------------------------------------------------ REVIEWED BY--------------------------- ----- ---- - DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------W ----- ----- ••--•------------------- Alterations and/or recommendations------------- ---- ---- --- -- ---------------------------•----•. --------•----•-- --- 1 _ --------' z-•1`��- ,surz -------a.-e.- - Qr� _.._. u�ec:._..r�roc `. -------- ---•-- ---------------------------- • q4. � t � , , --------------- ------ ------------------ --------------------------------------------------------------��`------. ----• ................. FINAL INSPECTION BY: -- -- _--- - --------------------------------------- Date. ---.---- ..� - ------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nort G' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1.57 F-P.CO.