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ii 11ry i i. APPLICATION FOR SANITATION PERMIT Permit No. l.l.... u (Complete in Duplicate) 3 r� T 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 with County.Ordinance No. 549. d 3 pp JOB ADDRESS AND LO ATlON-------&�-Gt---------- ----- � Phone ' one--- Name----------- - •---._ -------------------------------- -------------- --------- ------------ = - PoneAddress-------- -+ � Contractor's Name----------- +---- -----------� Installation will serve: Residence Apartment House'.❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑� Number of living units: ___ umber of bedrooms __ Number of baths ____j_ Lot size --- Water Supply: Public system Community system"[E] Private ❑ Depth to Water Table -Oft. Character of soil to a depthIof 3 feet: Sand ❑.Gravel-❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ r Previous Application Made:i`I"Yes ❑ No X New Construction: Yes ❑ No FHA/VA: Yes ❑ - No } TYPE OF INSTALLATION AND SPECIFICATIONS: i L o septic tank or cesspool permitted if public sewer is available within 200 feet.) }c k: Distance from nearest well-----__.-__i._ Distance from foundation-]k_____ _________.Material- _ _______:-________..____._--______ __--___,_-_-- No. of compartments-------------- ------- 5ize------------------- Liquid depth Capacity Ih Di al�Fliid: Disi-ance'from nearest well..-------- ------Distance from.foundation___-__-______.____.Distance to nearest lot line_________________ ;Number,of lines-----------------------------------Length of each line------------- --=" - --..Width of trench.------------------------------.-.- Type of-filter material------------------------Depth of filter material-------I-_-----It—--.Total length---------------"------•-------- See a e Pit. Distance to nearest ell---MR-Alb mp#eraal_e from- fou ds to n _' Distance to nearest lot line__ Number of pits L 9, f'C meter_ •d3 -- Depth �,� (� .� .,. _ _ — \3 . iameter------- --- --------- --- ------Depth------------------------------------ ei__--_Li uid Capacity------------------------ gals.Cesspool: Di.1from nearest well___ -_ Distance from foundation --------�____..Linin material-------------------------------------- I _______________ p q P Y ----------=-•gals. Privy:' Disi-ance from nearest well------------------- _-- - -�------- ---------Distance from nearest building_________ _______.__________.______-__. Distance` to nearest lot line--------------- -----_ 14------ ------ - �� •vv Remodeling and/o epairipq (describe,:______ _ :-- - -- _n 1 I herebycertify that I•have r ared this a licatiosan"10 4 • y ''` Q "p pp that the work will be' 144, in accordance with'San Joaquin County ordinances, State laws, and rule d regulation!:? a quin Local Health District. (Signed) --l__-- --------- ---------- and/or Contractor) I - 'iil I. --.-i-----.Title ------- By: ='= ( � ] (Plot plan, showing size of.lot, location of system.in.relation,to.wells,,b ' Ings„etc., can be place on reverse side]. 1=0R DEPAItTiGIENT�U5E ONLY CATION ACCEPTED BY----------------- ------`# '---------- - `,- DATE ------- ' REVIE DATE--------- y APPLICATION WED BY------• --------- -= ------- '------- ---- -=--- BEJILDING PERMIT ISSIDED ------ --------------------------------------------------- DATE-------js-�`--------- ----------------------- '--- - -- Alterations and/or_recommendations: - -----------------••------------------------------------------------------------------------------------:---------- 7-111 = .r �x �ss�r - _.___ "_ = "----------� � —.1-- ,r ��--------q-�------------------ d ----lj s------U 5 ^ � ----------------------------------------------------------------------------------•------------------ ------------- R ----------- . FINAL-INSPECTIONBY:----- - ._ Date-------- �' • -��--------------------------------------- ' II SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C” Street Stockton, California �I Lodi, California Manteca, California Tracy, California I� ES-4-2M Revisso 1.57 F.P,CO. r