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` APPLICATION FOR SANITATION PERMIT Permit No. ._. 7._.7_ 1\ (Complete in Duplicate) T Date Issued Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance wit County Qrdinance No. 549. 1� JOB ADDRESS AN LOCATION ------. =- 1 r�- . = .r` - Address_ y_. ----- =-=-�7.'-----------��-`�L Phone Owner's Name _. � t -° � `i`-f------------ ---� r- ------- -----•--•------•----------------------•--------.---••-•-------------------------------- Contractor's Name -. ------•----------------------- ---Z--------------- --------------------------- Installation ------------------------ Phone. Installation will serve: Residence 19, Apartment House ❑ Commercial ❑ Trailer,Court ❑ Motel [] Other-❑ Number of living units: _j----- Number of bedrooms _.3_ Number of baths _1=_ Lot size ----[_____________________________-----___'----------- WaterSupply: Public system ❑ Community system'❑ Private 4- Depth to Water Table . Character of soil to'a depth of 3 feet:4 Sand ❑ Gravel ElSandy Loam [-] Clay Loam ElClay E] Adobe Y Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) J'f� Se ic. Tank: Nob—is}of com artmentst well-__ 1t _ Distant fro', foundation___. -_. '.__-..Mat -ial----- - _�____- p p ....�� SizeX " Liquid depth CapacitY /41'�f, L } Disposal Field: Distance from,nearest II_---. j:.Distance from foundation____ _0____.Distance to nearest lot lineF`__�"6_... ^ p Number of lines--_-_=_.' _Length"of each line----- f�__: ________.Width of trench_____ ._�i'�_----------------- / \ Type of filter matetial.__r__07�N�_.Depth of filter materiae--------- _Tota# length----------- _ n_________________ tih '__T-Distance from foundation__::__"_"`"_____._..Distance to nearest lot line__..--------- ElPit: Distance to nearest well _______________ ❑ Number of pits------ ------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.____.._____._.____.Lining material______-________-__________________- ❑ Sizem: Diameter- ----p- - -------- r_____.Depth_p ____________________._____._._____ __Liquid Capacity-.. als. - ; -- =� Privy: Distance from nearest well-------------------------------- _ ____` ._,Distance from nearest building------------------------------ ❑ Distance to nearest lot-line--- = =------------ = ---------------------------------------------------------------- Remodeling and/or repairing (describe)---------------` 1 _-l' - --- - - �._._.-----_-•_ - - 1 -------------------------------------- 1 hereby certify that I have prepared this application and thaat 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. (Signed) ----- ------f A-A_A1---------'•---------- --------------------------------------------------------------------(Owner and/or Contractor By:-------------------------------------------------------------------- ......... ........ ---------------------(Title)----------------------- ---- F (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc:; can be placed-on-reverse-side)."- •�- ''— h FOR DEPARTMENT USE ONLYAPPLICATION i REVIEWED BY_ ACCEPTED BY----------..----- ----------------- --------------------------------------------------- DATE------------------------- ------ - - -- --- - / DATE---------- r - ------ BUILDING PERMIT ISSUED-------------------------------------------- V ----- -,f- DATE------------------------------------------ Alterations and/or recommendations:-------- -------• - --------•-------------------------------------------------------••-•-----••---•---•---------•--•-----••------•-------------- ------------------------------- ----------- ---------------------------------- =-------------------------------•----------.-•--•:-•--- ----•-•- -------=---------_-------------•-------------------- -----•---`-------------------------•----------•----------•-----•-------------------------------•---- ------•---- ----------------------------- ------------------------------------------- ------ ------•------------------ ------------------------------ -------------------------- --- -- -----------------•-------------------------------•----- ----•---------------------------------------------------------.------ FINAL INSPECTION BY------------- = Date------- - �-------- --- -- --------------^-•--•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strout 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--7-2M , Revised 1.5 7 F.P.CO.