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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ~ Date Issued fi 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 OCATION_______ _ S f _- ._ ---------------------------------------------------------------------------------- Owner's Name C >-------•- --------------------------------------------------------- Phone------------------------------------ Owner's -------1146f 2 _. - i�-� �j ------------------------------------•-•----...---------------------------------- Contractor's Name_____________ r ------------- Phon ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units:/--- Number of bedrooms _ _ Number of baths _- __ Lot size -_-- J-- -___ S _-__________________ Water .Supply: Public system ❑ Community system ❑ Private Depth to Water Table ,_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B- Hardpan ❑ Previous Application Made: Yes No I pp ❑ �f New Construction: Yes ❑ No Q�FHA/VA: Yes ❑ No [❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � _ . Septic Tank: Distance from nearest weli_� ______ Distance from foundation-_ _______Materiafe4.__ ----------- ____________________ No. of tom artments_.____. , ,� + --------Liquid depth____i2� .___.._'_C pati ._--fid _ p [ .------------Size--• • ------ ' Disposa'�ield: Distance from nearest well_ .3 --------Distance from foundation__�_d____ Distance to nearest lot ne_-______S_.... Length of each line--_'`-- -�S11-----_-----.Width of trench---- - -------------- Number of lines_______ _____________ g '� ---._-- Type of filter material-c5�_W1_. . Depth of filter material____. _°f___Total [i]� _ _ ; - length____-_--.-'�S:r______`_c�__-___ See a iit: Distance to nearest well-1�--_.F-__---Distance from foundation____�4__ _ Distance to nearest lot line__._ ____.__ ____ Number of pits______ ________ __Lining material__/_ Size: Diameter__�3..�_.____Depth____d..5 -______------_____ Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material--------------------------_.__-_---_- ❑ Size: Diameter------------------------ -------------Depth------[----------4---------------------------------Liquid Capacity-.-------------------------gals. Privy: Distance from nearest well____ ___________________________ ------ _._Distance from_nearest•building_______-_________--______-_._______._. ❑ Distance to nearest lot Eine---- - Remodeling and/or repairing (describeJ:___4---3---�---- __________ ------------- l ---------------------------•-------------------------------•------------ ---------------------------------- ----------- ---------------------------------------------------------•----•----------------------------•-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, andY#s and regulations of the San Joaquin Local Health District. 4(Signed)-----.--P-'- t --=-------- -------------------------------------- Owner and/or Contractor) By: /� � Y �f -, ------------------- (Title) (Plot plan, showing size of lot, location of system ination to wells, buildings, etc., can be placed on reverse side). OR PARTMENT USE ONLY APPLICATION ACCEPTED BY------ = = W�W--- U4_t P DATE_ REVIEWEDBY------------------------------------------------T- - ------------------------------------------- -- - - ----- DATE BUILDING PERMIT ISSUED------------------------- ----- AT -------- -- {-------------- --- ------- Aiterations /or recommendations:____-z. _ ___ �- �ry__-ice 4 ----------- 14� � - -- ---------------------- ...� L e --- _- `t�c i� ! �� ------------- Lim. . . u _ c --- t --- `'`-„ ----- ----------------------- FINAL --------------------- i S �� ' ssdS. V FINAL INSPECTION BY:------ 7 ,,,,c--------------------------------- Date._-at_--�(/•r1�I--S ----------------- 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.