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'fY APPLICATION FOR SANITATION PERMIT Permit No. __tl.6.25�....... 4 11 0 (Complete in Duplicate) 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 Or inance No. 549.V JOB ADDRESS AND CATION------�' =----- - -s`-`�-------------------- ----------------------- --- . ................... Owner's Name___.____ ------- ----------- ------- Phone- . ••... . ------: ----------- --------- Contractor's Name. - ---'� + ==----------- Phone .............. Installation will serve: Residence"A rtment House E] Commercial ❑ railer Court ❑ Motel Cher Co Num r of livin units: _ _ Z g .-_ Number of bedrooms __ Number of baths�--'- Lot size __,TT ��_-----------________________ Water Supply: Public 'systemg Community system ❑ Private ❑ Depth to Water Table�.�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Noo New Construction: YesC No ❑ FHA/VA: Yes ❑ Nol TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4eptic Tank: Distance from nearest well_________________Distance from foundation---_---------_--- ___�'f______--____--_---_____-____-__. No. of compartments--------------- ------Size--------------------------- Liquid depth-----{---------------� .. " t Dispos ield: 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_________________________Depth of filter material------------ __Total length-__---______._______-____________-.-__-__ Seepage Pit: Distance to nearest well_ z " Distance from undation�____. „ .Distance to nearest lot line- Number of its-.__ Linin materia Size: Di eter ------.Depth_--,;x__;%--------- --------- Number ------------- g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- Size: -_____ ____-_________-_--_________.Size: Diameter--------------------------------------Depth----------------------------- ------Liquid Capacity-- ------gals. Orivy: Distance from nearest well____ ________________ __-___________ -___;..__Distance from nearest building___.____________________________________ ❑ Distance to nearest lot line --------------------------- ---------------•----------------------------------------------•---------------------- Remodeling and/or repairing (describe):_ __ _ -- -- , _ � C" �.. ---- ---- ---- i" - �y ? --------- -------------------�-•--- -------------- ---------- ----------------------- 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 n regulatio of t San aquin Local Health District. (Signed) f - (Owne a /or Contractor) �C_ By ... :: � - - -------------------------------------------- (Plot (Title)- - ----- ------- plan, sho",in i e lot, ocatio system i re ation to wells, buildings, etc., can be placed on re rse ' e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------- ------------------------------------ ------ DATE--------------------------------- REVIEWEDBY--------------------------------------------------- ---------------------------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED --------------- - --------------------------------------------------- DATE------------ - Alterations and/or recommendations:------------- i A-----------------------------------------------------•------------- f -- -- ----- ------- -------------------- --------------------------------------------------- i ------ ---------'� --• ---- -------------------------------------------•--- --- ----------------------------------- - - - 7 �-- --------------- ppb ` ------ - -------- -- --- -- - FINAL INSPECTION BY:. ------- ---------- ate V ') SAN JOAQUIN LOCAL HEAL 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.