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�1 !\ APPLICATION FOR SANITATION PERMIT �i i,.{` �.��.3..... (Complete in Duplicate) emit Nom. pp 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 LOCATI �D ------ � ------------------------------------------------------------------- . Owner's Name. �. ------ ---- ------ ----- Phone.---•-• --••-- Address---� Contractor's Name Phone.._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: __k_ Number of bedrooms_- Number of baths :l_. Lot size -_z / _. !© '`................... Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table%J-ft10. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Et"H' ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Pq-'IVo ❑ 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 welixQ?kIDistan a from foundation..__14991......Matefial __-- No. of com artments_ _Size p Liquid depth . --------. CapacityV ... Disposal Field: Distance from nearest well 1�jy Distance from foundation ��--•.--_--.Distance to nearest jof line 9 l��„ Width of trench _. K Number of lines--------------___ _ Len th of each line_._. p ---------- -- Type of filter material _Depth of filter material—, --------------Total length.__.-7,b0--'?-.-—--' Seepage Pit: Distance to nearest well -__/40bistance f o fouJ�ation__..51kAP...._. D t c�to nearest lot line Number of pits-- ----1_____-----Lining materia A Size: Diameter--- __•._---Depth------020..... ..--..-•- 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 1771 Distance to nearest lot line ----------------------------------------------- -- - ----- •-----•-- -•---- Remodeling 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 rul s and regulations, of the San Joaquin Local Health District. (Signed) . ---- -Abi ------...Pwae-aadl or Contractor) By:---- ---------------------------- ----- -------------- ------------- (Plot plan, showing size of lot, loystem in relation to wells, buildings, etc., can be placed on reverse yT e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- -- ------------------- ----- REVIEWED BY------------------------------- ---------------•---- ----- DATE............~ BUILDING PERMIT ISSUED............. __..___.._ ___ ________----_ - DATE •i Alterations and/or recommendations ,` ---- • ........ r-"' �7 , --- _. s - -- -- ► ----- FINAL 9SPECTION BY% ..S •--•---- 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 ES-9-2M ^vised 1.57 F.P.CO.