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APPLICATION FOR SANITATION PERMIT Permit No. ../J�---7_2.q/fx /I �fj I (Complete in Duplicate) 5 S q Date Issued ___ ______->,/_/. Application is hereby made to the San Joaquin Local Health District for a permit to construct nd * tall the work herein described. This application is made in compliance with ounty Ordinance No. 549. �Q/Sf /,D�,y JOB ADDRESS AND LOCAT ON IYY--- ---' Owner's Name---------1 ! ------ Phone------------------------------------ Address---------- ---••-. v -----------•----------------------------------- Contractor's Name. ..�-------•---------------------------------•- ----•----•-••------------ ------- Phone--------•--•------•--------------•- -/ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .-. Number of baths .1__ Lot size _ C----.'___________________________- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ReeHardpan ❑ i Previous Application Made: Yes ❑ No New Construction: Yes PRo""No ❑ FHA/VA: Yes 9/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_ __ Distant rom foundation__ �.___-___.Mater�ly__ :_ - .____-______ (� No. of compartments__-__-- _-__--___Size__ _X_� -------- depth.... -----------Capacity.... _ W-_- �� Disposal Id: Distance from nearest well._ ___ Distance from foundat' -___Ir______-Distance to nearest tline_J... __.._.. Number of lines----------l ength of each line___` I�:� _ ------Width of trench--- WW �____ - p --------------------- Type of filter material.__ �,� epth of filter material__-_,r-Q___f--______Total length____- ________________________ Seepage Pit: Distance to nearest well _-Jor-----Distance fr m fofu dation___-� __..•_..D tante to nearest lot lin _ .__..__.. .41 Number of its______ __ _Linin material__ VC-Size: Diameter----,,,;9-________Dept h---AQ___-_-_________._- 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------------------------------------------ F ________-________-____-.-__-_-_- ____--.❑ Distance to nearest lot line------------------------------- ----- -------------------------------------------------------------- Remodeling and/or repairing (describe)------------------- a ' ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- ---------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 of the San Joaquin Local Health District. (Signed)......................... 4 ------------- -------------------------------------------------------Jllilhi��r Contractor) By:---------------------------------------------------------- -- --------- -----------------------------(Title)------ -- —-------------------------- (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------`-,--•��. - DATE J� - ---�------------------------ REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------ --------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations: -----------------------------------------------------------•------- ---------------------------------------- 'I: ........P_ -1------------Z------------0.-K-_----------. - ----------- ............-----•---------- •---------------------------------�/-nLft',�. �.K. •---------Tl.mxs -GE��1-------�'c-------------------------------- --------------- RFINAL INSPECT Y:.- Date " _ ---- - SAN JOAQUIN LOCAL HEALTH DISTINCT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North"C" Street Stockton, California Lodi, California Mantae4rtalifornia Tracy, California ES-9-2M Re&d 1.57 F.P.CO.