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' APPLICATION FOR SANITATION PERMIT Permit No. ._ s .: [Complete in' Dupliea+e) . .. A "N 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 applicatiori is made in compliance with County Ordinance No, 549, JOB ADDRESS AND LO ION._--__-�� ' - *�= - = -- Owner's Name--------- 9 d Phon -- ------------------------------------ ----- --- Address l sl---- l4 - ---� -----•--------•--------- / ----------- ----------------------------- ------` -- ----- Contractor's Name-----. �� i -- --------------------------------------------------------- ------------- ------------- ----------------------------------- -- Phone.-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court '❑ Motel Cher ❑ Number of livingunits: --,-/__ Number of bedrooms,, -- Number"`of baths Lot size ____, r - bedrooms,- 2-- Supply: Public:system iCommunity system El Private E] Depth to Water Table t. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ej Clay E❑ Adobe Hardpan ❑ Previous Application Made: Yes [] NoZ New Construction: Yes No E] FHA/VA: Yes [] No r` -f: TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pu6i.ic sewer is available within 200 feet.) l ptic T67-r '. ,Y Di_stance,from.,nearest.iv�IL________________Distance from foundation---------------------Materiaf__________----___-- ------------------------ Noof compartments --------------------------Size------ ------------ '- Liquid depth------------------ Capacity---------------------- . , Disposal Fi Distance from nearest well----.--------- ._Distance from foundation______________ Distaric to nearest lot line---------=------ Number of lines-----------------------------------Length of each line-----_-----------------�----_Width of trench------ --it _____---------- :, Type of filters material-------------------------Depth of filter material----------------- -----Total length--------------_i___+- Seepa Pit: Distance to nearest � from f ndation/Z_�__-.Distance , to nearest lot line__...>�.__-f-,_ Number of pits-----L_-------------Lining materia ____------ - ------Size: Diameter___ _i__ - -J , ------------ a� Depth = `2 ------------ Cesspool: Distance from nearest well----------------Distance from foundation_----_-__---__-:_:Lining material--___ f= ----- Size: Diameter --------------------- -------------Depth--------------------------- - ---------------------Liquid Capacity-. .x._-`-}----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building i ❑ Distance to nearest lot line---------------------- --------------- ----------------- I , Remodeling r repairing. (describe)-------�� - ------------------ - -— --I----.-, r ' •-- - - -- ---- ------- ._______��r.___ --_-_ ______________________ _____________ ____J-_______. _ c F - C^'_ . ---- ........ _—�f-. - ___ '1_. _G:�_1. !Yy(�__ - t ___ __________________.-----._---_._.----__--_- __-'�___s_�--5,1C ` 7 /�__�__ --------- Ihereby certify that I have prepared this applica.ion and hat the w r k will be done in accordance with San Joaquin County ordinances, to law , nd rules a, re ulations of 6 San oaquin L�al Health District l (Signed) w ---- -------------- ---------------[Owner and/or Contractor] By-—---------------- ----• y [Title) -- -- - ----- --------------------- •- -------- - !�7 -------- {Plot plan, showing six lot, cat' f s sfem i relation to wells, buildings, etc., can be placed on reverse si is FOR DEPARTMENT USE ONLY------------------------------------- APPLICATION ACCEPTS© BY -------• - ---------=------• = ----- DATE------------—---------- ---- ��- REVIEWED BY ----------- ---- -•--------- - - y� ,/ --- ------------------------------------------------ DATE----------=--- -- BUILDING PERMIT ISSUED . DATE ---- Alterations and/or recommendations:------------------ ------------------------;`-_ ---------------------------- _ ------------------- --------------------------------- ---------- ----- _ [ . ------ - . -----•--------------• ------•------------------ ----4----W - ------------- -CV _.. ---------- ----------------------- - {„ - ____ - - ------ ---- -r-------- '---- -�' 1 . --- -------- - � ` FINAL INSPECTION BYr__-- Date-------- ------"------------- - -- SAN JOAQUIN LOCAL HELT DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-211 . Revised 1.57 F,P.Co-