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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in-Duplicate) /a Date Issued ------`_t-/s.7__. 1 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. rt �) JOB ADDRESS AND LOCATION -, ---------- Owner's Name------------ ------ - --— ---- ------------------- ------------------- Phone.--- --------------------------•---- Address SF;;2,0 --- - - ---.. Contractor's Name--_--�___Zz---- -- - o ` -- �_-------------- Installation will serve: Residence 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other [] Number of living units: j___ Number of bedrooms _Number of baths __/___ .Lot size .-__- __._ ��_ _-_.___________ Wafer Supply: Public system 4 Community system ❑ Private ❑" Depth to Water Table -_OUft. Character of soil to a depth.of 3 feetr Sand ❑ Gravei ❑ Sandy Loam ❑ Clay Loam E] Clay [I Adobe,E Hardpan ❑ Previous Applicafion:Made. Yes [] No R New Construction: Yes ❑ No jK FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: jNo septic tank ori cesspool permitted if public sewer is available within 200 feet.) Se 1"1 ank: Distance from nearest well_________________Distance from foundation----------_---------Material--------:_____.__.____..__..__n__..__-_.______- El No..of'compartments----- -------------- - Size---------------------------- Liquid de th_ capacity Dim al iel Qistance from nearest wefl__./VVWDistance from foundation-----7- to nearest lot line___._�---__- Number of lines----------- Length of each line------ —'---________.Width of trench---� --"---- -_______--- ' Type of filter material______R0C/<_Depth of .filter material____ -----`_____Total length____1'��_____________________-- Seepage Pit: Distance to nearest well____ rT/�� Distance m foundation_._'=T---------.Distance/to nearBst lot line_______.___.. Number of ;ts.___F:/_-----_-- _ Linin material____ �C, Size: �. P- --- 9 - - - ��-�--- Depth---�aS------------.,�-��-- ,,y Cesspool: `. Distance from nearest well________________Distance from foundation--------------------Lining material---__________.______ -------- - ❑ Size: Diameter------k-'----- •--=-----------------Depth-------------------------------------•--------------Liquid Capacity_-------------------------gals. Privy: Distance from nearest well._-----------------------------------------------Distance from nearest buildin------------•----------- -------------- __ - ❑ Distance-to nearest lot line------------------------------------------------ -•- ---------------------••----------------- - - Remodeling and/or repairing(describe)----------- -- / -------..----- -,----- --- ------------ �j V'- --------------- - - { d -- ' --- - - �--•-------------------------- --------------------------•---------=---------------------------------------,.......-------------------------------------- - =- -------------------- - = I herebycertify that I have prepared this a lication and that the work --------------------------------------- y p p pp k will-be done in accordance with San Joaquin County ordinances, State la and rules andiregul 'ons of the San Joaquin Local Health District. (Si ned �-� ` 9 --------- ---' ----- - ------ ---- ---------------------------(Owner and/or Contractor( By----------------- -- - ----------- ---------------------------------------------------------'---(Title)�" f {Plot plan, showing size of lot, location of cyst in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT-USE ONLY APPL1CATlON ACCEPTED BY-----------!------------------- -- �/ DATE----------_._.._----- - - - --------- ------------ - ------------------ REVIEWED BY-------------------------------------- __ ------� - DATE----------- ------ ------ BU1LDlNG P! RMIT ISSUED _F �-�, =---i- DAT --------------------------------------------- ------ -Alterations and/or recommendations--------------------------------- ------------------•------•---------------- ---------. ----------- --•--------- ----------------------- Y—------------------I_ r _ f .� - -��-------- - '�---------- -- -- ------------•--- ------------------------------•---------------------_-- ------ ._.. _ --------------------------=-------------------- ---- -- --- -- - ' -- ---------------- 7- �- -r ----------------------------------------------------------------•-----•--- r /%,)FINAL INSPECTION BY:- =` v' ----------- Date--/� ' ---`=--5 --------------------=------------------- SAN JOAQUIN LOCAL HEALTH 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-9-2M Revised 1.57 F.P.CO.