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f � APPLICATION FOR SANITATION PERMIT Permit No. _ S_c (Complete in Duplicate) JJ Date Issued -____/..__/___ i Application is Aeby made'to the San Joaquin Local Health District for a permit to construct and install the work heIrein-described. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS ANDL ATI /--- - --- -----1 ? Owner's Name------------ ---------------------------------------------` ------------------------ -------------- P hone_ --------------- • t -•---------- "- Address--------- Contractor's Name -d - -- --------------------- - ------ --------- Phone........................- Installation will serve: Residence gk"�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other' Number of living units: _/__-_ Number of bedrooms Number of baths -_1_- Lot size __ _------------------ Water Supply: Public system �KCommunity system ❑ Private ❑ Depth to Wafer Table . `ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No P'•—New Construction: Yes 0--No ❑ FHA/VA: Yes ®slob ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , i Septic Tank: Distance from nearest well__/_,_ Q__Distance from foundation____ _----------Materjal--- % -- ......... ---------_-- 2y___ 2y___ No. of compartments --.--Size_. /. ._ 1 P - - x- Liquid depth "{ Capacity.,.. _-- Disposal field: Distance from nearest well . .__Distance from foundati n-___I a0 _/.._Distance to nearest lot line.... Number of lines-------- __________________Length of-each line----- �___ --------Width of trench---A_ ....... __ ----------- T e of filter material-/-- -__ f<- e De th o0ilter material._- APS Type � /�- >�- p �----------�---Total length--------��-��----------.................. Seepage Pit: Distance to nearest well -/14-/6-�-_-Distance fr m fo ndation___--!` _...Distance to nearest lot line '�� Number of pits___ ___ _______Lining material..-_ __�G_-Size: Diameter_-_-- __ _____Dept h----- __.----______ N. Cesspool: Distance from nearest well________________ Distance from foundation--------------------Lining material-----------------------------._______- ❑ Size: Diameter--------------------------------------Depth------ _------------------------------------------Liquid Capacity----------------- gals., Privy: Distance from nearest well____ ___ ___ __________ _.--._Distance from nearest building------------------------------------------ Distance ___-.-___._--___-_____.__--___-__,.Distance to nearest lot line__- ------------------------------------ ------------------- -------------------- ---------------- ----- IC- Remodeling and/or repairing (describe)-------- ------- �_ � -------------------------------------------------------------- ------------------------------------------------- ---------------------------------------------------------- --------------------------------------------------- ------ --• -•-------------- ----•- ---------- --------------------------------------------------------------------------------------------------- ------------- -------------- --------- 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. (Signed) `- --------- ---- - ' C 11-- r Contractor) --- ------------- - --- ----------- --- � � BY: ---------- --------------------------------------- - (Titlep. C% z ._.. -- - ---- ---------------- (Plot plan, showing size of lot, location of s m in relation to wells, buildin s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_74---tA_,O`------ --------------------------------------------------------- DATE------ ---- ----------------------------- REVIEWED BY-------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- ----- `` ----. DATE------------------------------- ------------------------------- -- - ----------------------------- Alterations and/or recommendations:--------------------------------------- -------------------------------------------------------------------------------------------- --___._ ------- ----- --- - --------• --- t t FINAL INSPECTION .> ------------- Date S� _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 SycamoreStreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 P.CO. /!fir'