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APPLICATION FOR SANITATION PERMIT Permit No. _.__._ _.3.._ � J (Complete in Duplicate) ti 13 'Date issued ___ _ � Application is h eby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �1 This application is made in compliance with County Ordinance No. 549. JOB ADRRES AND LOCATION------- �� -------------------- - �l_ Owner's Name----------/�=.1 f?/ -------1,1•�A�. _'�C..Z --------- _ ---------- - --- . Phone- --------------------------------- Address------- -- Contractor's Name_ ---------------- Phone Installation will serve: Residence [D--_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._ Number of bedrooms _ Number of baths __ _ Lot size _. - �, Water Supply: Public system Community system ElPrivate ❑ Depth to Water Table.& ft. _ ------------------------- Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑" Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No RD' New Construction: Yes Vj---No ❑ FHA/VA: Yes j�-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 weil_/� j!/'Distance from foundation.....f��--_-.Material___ _el Z No. of compartments.__ - -- ------------SizeCa aci u-- s�a 'J�:._��/_`_Liquid depth___--- �'' - �_.---- P •�' - -fir"------- Number Field: Distance from nearest .well/�l�/�%�Distance from found,ation_...lT .Distance to nearest let line__e5-_____--- ( Number of fines - Length of each line---------9�-----------..Width of trench. . /// Type of filter mater;al_,�� J I' Depth of filter m'aterial__ �'__-iota! longth-___.__ '_._11 - --- --- - Seepage Pit: Distance to nearest well_A/f4 -__Distance from foundation___lj2`.Distance to nearest lot line___14 --- - �r �. Number of pits---- ------------.Lining material-_-A(?-Z-�_Size: Diameter__29-._. -- - Depth- •-�---��-�------ esspool: Distance from nearest well---_----- ..__-_-Distance from foundafion.-------------- --- Lining material---------------------•----- ------ ❑ Size: Diameter------ ----- - ---------- ------..Depth- ----------------------------- --- -------------- ._Liquid Capacity- --- --------- -------gals. Privy: Distance from nearest wel!------ --------- ------------- ____-_Distance from nearest building ----------- ❑ Distance to nearest lot line- ___________ _ -9- .__ -- --- ---- ----'--- __ Remodeling and/or repairing {describeJ: � � l �._ - --- ------------------------ --------------------------------------------------------------------------------- -------------------------------------------------------•---------------- 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)--------- --- - --- -'mac' �--- By:------------------------------------------- ----------- -------------------- ------------------- - - Title Contractor] -- _ (Plot plan, showing size of lot, location of,,, em in refation to wells, buildings, etc., can be placed n reverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.___.-------------------._. - --- -------- ------- -------------------------- DATE---- �-------- - REVIEWED BY---- -----------------------------.. ..... . .. . . }0 - - DATE -/ f_ 3 ---- `f BUILDING PERMIT ISSUED----------------- [---------- --- ---------------------- ------------ . -- DATE------------------------------------------------------------ -- ----------------- -- terations and/or recommendations__________ . -,- _- - ---�- - ------------- --------------------------------------------------------------- --------------- ----------------------------- ----------------------------- -- - ------------- r `-------------- FINAL INSPECTIOiV—�Y- __ �l '.- --------- --- -_-1 Date----- ._ 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 FS-9-2M 1 Ravisea 1-57 F,P.CO.