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APPLICATION FOR SANITATION PERMIT Permit No. --94_'7-7 (Complete in Duplicate) _ Da#esued ---�//� Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. Tis plication is made in compliance with Coun Ordinance No. S49. . JOB ADDRESS AN OCATION:.--- Owner's Name -------------- ---------------- - !ry 2 63Q -------------- ----- --------— - - - -------- -------------------------------- Phone---------------------------- Address----- V_ 0 If n --. ----- - �- /Sn, = = Contractor's Name........ ! � A;19� 2 - ------------- ••.. r ../t �. aPhone J ------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer ourt �` ❑ Motel❑ Other �,� Number of living units: _-_---- Number of bedrooms ._------ Number of baths p - of size ------ --- I ---- --•------- ----------------- Water Supply: - Public system '❑ Community system ❑' Private 'Depth to Water Table lcZ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam [� ❑ Y ❑� Clay Loam ❑ Clay ❑ Adobe❑ .Hardpan ❑ Previous Application Made: Yes ❑ No New Consfruction: Yes [] No �FHA/VA: Yes ❑ 'No 2-` TYPE OF INSTALLATION AND SPECIFICATIONS: 4. ' (No septic tank or'cesspool"permitted if public sewer is available within 200 feet.) t Tank: Distance from nearest well----._#_- -__- Distancefrom foundation---------- -------.Material_---- _---__-__-____ ' No. of compartments-_- --- Size --,--Li Liquid de th-- ------_-- _ i -------------------------- ---------- _.,..,.,� q p. -- - Capacity. Disposal iold: Distance from nearest-well """"""" T""' Distance fro foundation:_�Q_--.-- .Distance to nearest loft Number of lines'--------1 �=-----.--RY Leng#h of-each-line- - 00-':_—___. ,Vidth of trench_----a{�_f_----- Type of filter material-_s� _--- ___Depth of filter material------/Z__/__ Total length____----- �-f__- Seepage Pit: Distance to ne es#well _ Distance from foundation______............ Distance to nearest lot line----- Ej Number of pits--1--- Lining" material --_ Size::Diameter--:---1'{--- --------- Cesspool: I -----Depth-------- -- --------- ------•• Distance'from nearest welL----------------Distance from foundation-------_---------_.Lining material- -__.-----_-____ ❑ Size: Diameter---I "�"""""'".. ,: ------------- Priv I --- - ......... """"'.---- ----- ----Liquid Capacity gals Y: Distance from nearest well-----------------------____-_ - _--Distance from nearest building----- ------- ----- D{stance to nearest let line i _-,____ 4 ------------------------------- - Remodeling - ------ Remodeling and' repairing (describe)___________ ----------------------------------=-=-------------------------------------- -------------- ---- __- -- _ - ------- I hereb citify that i have prepared this"application`and that the work w-lhb---------=--------------- ---------------------------------------- �r ordinances, St law and le and regula ons of the S Joaquin Local HealtheDistrict,done n accordance with San Joaquin County (Signed) € i - wner and/or Contractor)` Br = - - ?-c� ,- -�-��----------- {Title) ---------------------------- (Plot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). r ( - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --._ �__ _ ____ __ __ _ ----------- --------- DATE ------------------- -------- DATE S? --------------------------------------------- UILDING PERMIT ISSUED_---------------------------- ----- ---- DATE-_- 'R ---------------------------•----- ---------- ---------------- erations and/or recommendations:_t----------- ---- ----------- ---------------------------- --------- ------------------- t -----•--•-- ---•--------------------------- •------------------------•----------- -----------------------------------•------ • -----------------•--__.----___----__----__----_•_--_--------_---•---__-------__•.--•_--_---__---•_---------------------- --------------- ----------------------- ------------- F]NAL INSPECTION,BY: _ G -- - --°---•------�-=------ Date---j--------- -------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT s` 4 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F.P.CO.