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Ay APPLICATION FOR SANITATION PERMIT ' Permit No. ..... -_---_------- (Complete in Duplicate) �// Date Issued -------,(-/Q��:_ 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._-- _ �.-, ?�_-___ �.�.. ----------------------I------------------------------------------------ Owner's Name -------------- -- Phone --------------------------------------------------------- ----------- Address L®-------- - - - - -- -----------------------•-•------------------------------------------ Contractor's Name------------ -- ----- a -_. ---------- Phone Installation will serve: Residence [,"Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel ❑ Other ❑ Number of living units: -Z-- Number of bedrooms -- Number of baths _?_ Lot size f -_________ Water Supply: Publics stem Commuriit system ` Pp Y� Y y y ❑ Private ❑ Depth to Water Table oco-T+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' lardpan ❑ Previous Application Made: Yes [❑ No Imo' New Construction: Yes ❑ No [E— FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -----_-__-----___--_.-.-----.---.---_._----.-. ❑ No. of compartments-------------- -----------Size--------------------------------Liquid depth=-------------------------Capacity-----------•----------- Disposal Field: Distance from nearest well-------- ------Distance from foundation__-------_.----.--..Distance to nearest lot line--------.-__---_- ❑ Number of lines-------'----------------------- Length of each line--------------------------. .Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------------•--------- Seepage Pit: Distance to nearest well--1-per-/ ---_Distance from fours tion_f?, ----------D stance to nearest lot line------ -- -------- Number -----_Number of pits-----/-----.-----__Lining material ize: Diameter- �___--..Depth-- ---__------_- 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 to nearest lot liner - --------------- ------ - ---- ------------------- �. ----------------------- r w 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)------------ ?, hocailon -` r - ---------------- r ontract By: ;= '� - (Tf#Ie) ------------- ------------------------- I f or) (Plot plan, showing size of of system in .relation to wells, buildings, etc., can be placed on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----•--------- -------------- ------------------- --------------------------------------- DATE---------------------- REVIEWED BY-------------------------------------------- ----- -- - ------ DATE------------- }n BUILDINGPERMIT ISSUED---------------------- -- - - ------------------------------------------------------------------ . DATE----------�--------------------------------------------- Alterations and/or recommendations: ----- ---- ------------- = �----- f �� -/ ----- r � 7r- lG'�iC r �..4.......----.A_ -----------------------------------------=-d-- =----C .-Cat_ 1s °�S/----s�"--�`=.,� !alf-. ----4L(A-8 - ----,!!!.d'.dLA1l�E. -=----- `L-Es:S.t-�+ - --._...------ p. : :---------- -----x f�_'_-�. --------------C-----------------------6----- FINAL INSPECTION BY---------- --- e—)----- Date--- ----- _� Q JOA UIN LOCAL HEALTH DISTRICT " 130 South American S#reef 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 FT.CO.