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/{A APPLICATION FOR SANITATION PERMIT Permit No. q '1 (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION� ] ------ ��`'t`�--^ C�� lJ�f-----------------------------------------------------------------------------------�� L) - Owner's Name----------------4_, _-,----/----�-we------� / � ------------------ - --------------------- Phone Address----------_------------r��.... -}�- _ �-1/�GJ1y� = Contractor's Name----------------------------- V , Phone � Installation will serve: ResidenceApartment House E] Commercial ❑ Trailer Court F] Motel F] Other E]Number of living units: ___ ___ Number of bedrooms __7-Number of baths J--- Lot size _______r ___ _ -------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __"- t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ Na l FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Ste,?F is Taf,4/1 Distance from nearest well-_.____________Distance from foundation__.____________-__.Material- __ ________________________________________ _ __. (y /"'dS !, -. No. of compartments-- -----------------------Size--------------------------------Liquid dept-.------------------------Capacity---------------------1 Disposa i Distance from nearest well_._______Distance from foundation_____ _ Distance to nearest lot lin /� Number of lines________ ________ _______________Length of each line___ __ Width of trench__-- - ------------ I ;��" g "t Type of filter material-_--_lir / ___Depth of filter material-___s�-----------Total length_______;`- 7---------------------e- Distance to nearest well_---5,N Distance om foundation_-_. _/__01.........Disfan to nearest lot line_ �--__----_ L '� `�� Number of pits.._.__.____--____Lining material-: $ ,+`Size: Diameter--g-3_---_-._---Depth---QJa�- � _ - ------------- Cess ool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-------------------------- "k ❑ Size: Diameter-------------------------.-------------Depth--------------------------- ----- - ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __________________________________Distance from nearest building.________-------------___________________. ❑ Distance to nearest lot lire------------- ------------------------------- Remodeling and/or repairing (describe): ------ .-- ��----------------- -- ----------- ---------- -�./ - -------------------------------------------------•------•--•-------------------------------------------------------------------------------------- .: �I _ — ---------------- Ihereby*rythat I ha a prepared this appllii ion and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and ues. an regulatio�of t San Joaquin Local Health District. J (Signed) - F ---- ---- -- (Owner and/or Contractor) By:-------------------------------------------------------------- ---- ---- ----- -----------(Title} (Plot plan, showing size of lot, location of system in r a ion to'we s, building , e c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ------ -- . DATE ------------- REVIEWEDBY----------------------------------------- ------ ------------------------------------------- DATE --------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- ------ DATE----- ------------------------------------------------------- Alterationsand/or recommendations:-------------- ----------- ------------- ----- ------------------------------------------------•-••-------------------------•-•---- --------------------------- ---- ------------------------------ -------•-----------z � ---- , ------- ----------------------------------------------------- I - 7- - --------- ------------------- - - ---------------------- ----------- ----------------------------- ----------------------------------•---------------------------------------------------------------------------•----------------------------------------------------------------------------- -------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- FINAL INSPECTION BY:-------01(1�2----.----------------------- ------------- Date------t--`---� ------------- -- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh 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.