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APPLICATION FOR SANITATION PERMIT Permit No. .. ..d (Complete in Duplicate) Date Issued -_ IS Application is hereby ia e to the San Joaquin Local Health District foraermit to construct-and install the work herein described. p I This application is made in.compliance with ounty Or in nce N 549. � 3 ��r JOB ADDRESS AND LOCATION ----f l � ------- ----•-•----------------------------------------- Owner's Name------------ 1 -- Phone----------------------•------------ Address---------------------------------If t�1---------- ----'--------------------------------------------------------------------------------------- Contractor's Name - ' fit - �-------------------------•-----•-------------•-------------•-----•-- Phone----------•----------------------•- Instaliation"will serve:, Residence g3---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms Number of baths __/_. Lot size ___ _________________-____-.____-__ Water Supply: Public system ❑ Community system P3'Private ❑ Depth to Water Table -,$,iL ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ErHardpan ❑ Previous Application Made: Yes ❑ No 9?"' New Construction: Yes E"No ❑ FHA/VA: Yes P' No ❑ i 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 foundation_-/P-----------Material...t __t� � _______ No. of compartments______.�- __-____-.Size__ __-X--��-------Liquid depth--J--------------------Capacity----f40W--• Disposal Field: Distance from nearest well--.-- ------Distance from foundation-----13(1----Distance to nearest lot line----%_J__ !,__ ©� Number of lines--------®Z____. _ _Length of each line__--_ O-______________Width of trench____. _�' Type of filter materiaL1a2_11?,rfX_-Depth of filter material------1_f�`_----Total length--.-_";e1 ------------------------- Seepage :---__-__________•_-___ �\ See a e Pit: Distance to nearest well Distance from foundation-__ 9 p g -___ �?� '___.Distance to nearest lot line______ �^' Number of pits.__--�-_-_.____Lining material--- , '___Size: Diameter_-_J�`_ .---- 2_�i_'',/1�/9�� Cesspool: Distance from nearest well-----------------Distance from foundation__----------------Lining material________..________..___-_.-________. ❑ Size: Diameter--------------------------------------Depth---------------------::_.----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------- from nearest building------------------------------------------ Distance _ _-____-______________- 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 rules and regulations of the San Joaquin Local Health District. (Si ned 9 )---------------------- -------•-------—----s-- �------=-------------- ----------------------------------------------------------------( Contractor) � G BY:----------------------------------------------------------- --- ----- ----------------------------------(Title)------- ---•------ ---------------- (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY--------1--xRcO-P---------------------------------------------•-----•-------------- DATE--------6�_��_" { REVIEWED BY-----------------------------------------------------------------------------------------------------------------------. DATE---------------------- ------------- ; BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------ ------ ---- f�j -------------------- � rr+e- A1�� ; 2f A s j-------•------- - -- - - - - ---------------------------------------------•-- ----------- ------------- -- _____________________________ _________________ _ ___ _________----_--- ____ FINAL INSPEt-T4 --- ---- -- ---- -- - Date--------- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M Revised 1-57 F-P.CO. I