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s 7f� APPLICATION -FOR SANITATION PERMIT Permit No. ._�.___""_.�. fvvi� Jr t (Complete in Duplicate) r, Date Issued - t _ 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 C9. ounty Ordinance No. 549. � ..P JOB ADDRESS AND CATION" _ __ L" Owners Name Qy - � � - -------. --- Address one Contractor's Name". Jc -^ - �Z2� = - ` � •------------------------ - ------- Phone .+d_��.� ��-'�___ Installation will serve: Residence ®-'Apartment House ❑ Commercial ❑ Trailer Court / E] Motel ❑ Other ❑ Number of living u lits: /_ Number of-bedrooms,,-Number,of.baths.s,:� Lot.size S r- --- . - V k2 ------------------- " ,- Water Supply: 'Public.system �Commun4ty system El 'Private ❑ Depth to Water Table >« ' jf _ ft. Character of soil to a depthof 3 feef:i Sand E] Gravel ❑ `Sandy�Loam❑ Clay Loam ❑ Clay [] Adobe �ar`dpan ❑ Previous Application Made: Yes E] No ® New Construction: Yes ®-Vo ❑ FHA/VX Yes �No lw.l TYPE OF INSTALLATION..AND SPECIFICATIONS: ❑ � (No septic tank or'cesspool permitted if public sewer is.available within 200 feet.) 1 > Septic k: Distance ,from nearest well" Ib.istance from foundation_y _0 __.Mater# _' ----- No. of com artments ' r `-'Size...---��,n-�� Liquid depth------ -- �--------Ca acit c- _'� D•ssposal ield: Distance from nearest wel_ Distance from foundation" Distance to nearest lot line-� ----.. Number of lines_--�_> Le'ngfh of,each lma'_ A ii--9 Wiclth of.trench_.___.:; . _ � 1, r f, -- Type of filter materia ls� _ -- ,,,ape tib of filter material--." i I Total length- ----------------------- Seepage Pit: Distance to nearest well"_ --:_'------D.istence"from foundation:_:" :___.Distanee to nearest lot line_-__"_-._".."- ❑ Number of pits.__ ------ ming ma erial _ " _ --------------- -_ -----,_ --..Lining material-- -{ I Size: Diameter- ------ -- Depth-- ---- --------------- Cesspool: Distance"from nearest well------------------Distance f�om foundation ❑ Size: Diameter------------- - De,�th =' Li uid Capacity_ q P tY--------------------------- Privy:' Distance from nearest well_.. ------- ___________ _ _ -_Distance from nearest building#: ❑ --- Distance-f6 nearest lot-lin. - ..... g ----- --------------------- -- ----- Remodeling and/or repairing fdescribe -------- -- .c.1 _lr ;- - - - — ---------- ; . ------- I hereby certify That I,have. re a`red this application and fhaf!fhe work will be done in accordance with San Joaquin Cou ordinances, f to laws, d rule n regulations of the San Joaquin Local Health District. (Signed)--------- i �. caner and/or Contrac gY= --------------- -- -- .J ----------(Title-- Plot plan, showing size of lot, 'location sof system in relati n o wells, buildings, etc., can be placed on reverse side). —J FOR-DEPARTMENT USE ONLY APPLICATION.ACCEPTED�BY. _._-" -------- -- ------------------------------------------------------ DATE- ------------------------------------------------------------------ REVIEWED BY ------------ = DATE.- - -- --- -- .. BUILDING PERMIT ISSUED-----.----•- _ -=--------=-------- -- ---------------- ------ DATE------Sin------- Alterations and/or recommendations-------------------------- CA -----11---------------------------- --------------------------- -------------------------------------------------- } ------------------------------------------------------ ---•---------------------------- - -- -- - --------------------------------------- FINAL INSPECTION' - _ Date------- --------- ---------------------------9--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street 132 Sycamore Sfree} y 814 North "C" Street Stockton, California Lodi, California Manteca,-California Tracy, California r ES-4-2M Revised 1.57 F.P.CO. t