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APPLICATION FOR SANITATION PERMIT Permit No. .__ .d/3 . /I Z (Complete in Duplicate) tJ- `( Date Issued ' 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 CATION.__Sl> _-�F �/ A�_ , ` ._ x Owner's Name___._______ �/ ----------------------•--------------------. Pone-----•---------•------------- �y,� -----". Address _ ��----��---els---* -�/�1�----`- - Contractor's Name________________ __ - . Phone_.._._... - --------------------- --------- Installation will serve: Residence Q�J-Apartment House ❑ Commercial ❑ Trailer Court 0 Motel Other ❑ Number of living units: J--- Number of bedrooms An. Number of baths Lot size � //,�� Water Supply: Public system [j Community system [I Private [I Depth to Water Table . tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( ardpan 0 Previous Application Made: Yes ❑ No U2/New Construction: Yes Ra"No ❑ FHA/VA: Yes K�' �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 well__ ,Distance from foun No. of compartments__ dation.. __.___..Mater�ah__. 'G --�----___. :_._Size_ �` �-_••_Liquid depth---- L y >� ---Capacity--... ...... Disposal Field: Distance from nearest well AP-7/r/Distance from foundation;_: ____----Distance to nearest lot line_ - ZK Number of lines-------.l__ _ Length of each line____ Q _ Width of trench.<_A_� I.._„_"•__,•__," ---------- - Type of filter material ,G_ Depth of filter material IePe_e _":Total len th___ ___. ' g - �� -_... --- --.••••. Seepage Pit: Distance to nearest well_ __Distance from ibundation---- �} �•- � .. r,( z�!61.....D st nce to nearest lot hne__. •;_._--._ Number of Pits-------C__---___.__Lining material..A*0-_.! __..Size: Diameter._- _--__-Depth.-_, 3.( ....._ ._•....... 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 a r_1Distance to nearest lot line--------------------------------------- Remodeling and/or repairing (describe):-__._ ----- ----- - �r ---•----------•----------------------------------- ------------------------------------------------------------------------------------- - ---------- ---------- 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 rule and regulations the San Joaquin Local H alth District. r (Signed) (�?r Contractor) {� By:........................................... Title (Plot plan, showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ---- .......... - DATE----------- REVIEWED BY. - ---- --------- ------------------------------------------ DATE------- _ "s ----- ------------------------------------------------------------ DATE ----` BUILDING PERMIT ISSUED_------------------- ". ______ Alterations and/or recommendations:-__-__--- 7 ------ --- 5-8 .•---•� ---------- --------------- -------------/ ----- - -- FINAL INSPECTION BY:----._. . _ Date....... ."-- ---------- - SAN JOAQUIN LOC HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straat Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P.CO.