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APPLICATION FOR SANITATION PERMIT Permit No. J,,��•-...___ (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 MtH County Ordinance No. 549. JOB ADDRESS AND LOCATION -�Co c -------13,, A, ------..ae, .V k Owners Name---------- •�r---- - d -�:�---=------------------ --------------------------------------- Phone--'-;---------------------------- Address �a.D_ - 1]-'- a.�.Q- --------------------•-----------_--------- Contractor s Name------- --! ---6`=ay_t)---4/ 'o Asia � �lF� Phone._-. Installation will serve: Residence Apartment House El Commercial Trailer Court El Motel Ej Other r Number of living units: Number of bedrooms g ..3-._;Num berFof baths Lot size --- lQ.� �`5 -------------------------------- Water Supply: Publicf system E] Community system [l��rivate`❑ .Depth to Water Table _..._-.. ft. - - 3" , Character of soil to atdepth of 3 feet:, Sand ❑ Gravel ❑ , Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe gr'f:�ardpan ❑ Previous Application Made: Yes ❑ No' New Construction Yes 94--Vo ❑ FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank cr'cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest weP�_Y_-Distance from foundation.-.-----.- -_.._,Ma erial-------. .__ No. of compartments___'_2------ _'-size-1)x . _-------- Liquid depth-... � _ Capacity..... Disposal Field: Disfance from neares# well_rY1nM.�._.Distanccefrom foundafion.�:--.._...-Distance to nearest lot line--- [!�/ Number of lines....... ... ..:. 1 Length of each line-_....�o_Q.t..._� Wid#h of +rench._.�L]_.__ Type of filter material.._ ----Depth of filter material-_-/_8.............Total length....._._I1...__.----------------- Seepage Pit: Disfance to nearest well-___'. . "'--_-_Distance from 'foundation....................Distance to nearest lot line.......+--------.- k ❑ Number of-pits ---------------- Lining material-----------------------Size: Diameter'-----------------------Depth--------------------------,------ Cesspool: Distance from nearest well_....'....------:Distance from foundation--------------------Lining material....-.---.-.-_----.-------...._-.-._.. ❑ Size: Diameter ;Depth = ---------------------------- -----Liquid Capacity--------------------- -gals. Q Privy: Distance from nearest well___'............... ..:......._-...-_- .__Distance from nearest building.l----------------------------------- r ❑ ._,,. I. Distance to nearest lot i ... .__.:. ----------------------- -------- - - r Remodeling and/or repairing( describe -------------------------------------------------------------.---- ---------------•-----------------------------•--•---------------- -------------=-------------------�------•--------,------ I F 1 i . w ---------------------------------------------------------------------------------------------------------- ----------=----------------------------------------------- = 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. , (Sir r 9 - �------ --- -- --------_�-- ----=----------------•------------------------------------------------------------i-----(Owner and/or Contractor) By-------------------------------------------- -----------•-------------------- ---------------------------------------- itle)-------------------------------------------------;•-_--------•-- (Plot pian, showing size of lot, Iota+ion'of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY... . .... .......... . .... DATE �-�-�---------BY------------------------- --------- ----------- ----------------- --------------=------------------------------------------ DATE---•-----------------I---------- - ----------------------- t BUILDING PERMIT ISSUED-------------------------------------------------------------•-------=------------------------------- DATE------------------- Alterations and/or recommendations:--------------------------------* ----- ---------- ---------------------- ----------------------------------------------•--......----------------•-------------------•---------------------- •- ---------------------------- ----------------------------------------------- -------------------------------------- i _ --------------------•- •----- -----=- ------------------•---------•-•----------------------------- -------- -•-----------------------------------------------•---•--------------------------- -------------------=---------- ------'------------------------------------------------- ----- ----------- �- -------- --------------- ----------- i FINAL INSPECTION- = t+'--- r -..-. - - 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 —9-2M Revised 1-57 F.P.CO.