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APPLICATION FOR SANITATION PERMIT Permit No. ...f____,..___.,� a � (Complete in Duplicate) This Permit Expires 1 Year From Date Issued This Issued Application 3sere y ma; 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----- _ _ -------- --, ----"-•-••r Owner's Name--------- ------------------------------ - _----------------------- ------------- Phone------------------------------------ Address--------------------- ------ ----------------------•------- Contractor's Name -_ ¢'. � ` '[ w`' -------------= ._ ,?7 ---- Phone ._ ,x_1---"- Installation will serve: Residence [ .Apartment House ElCommercial-❑ Trailer Court ❑ Motel ❑ Other Els r � r Number of living ur its:,¢./-- Number of bedrooms --'X- Number of baths __1___ Lot size ----- 0- ----.f- --` ------------------- Water Supply: Public system r, _t/0-system [I Private ❑ Depth to Water Table Oft. Character of-soil to a depth of 3 feet: Sand•❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe{Hardpan ❑ Previous.Application Made: Yes '_El No�New Construction: Yes ❑ No'Uf-, HA/VA: Yes E] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T,�' Distance from nearest well_ ,44/110,Distance from foundation___________________Material____.___...___.- _---..-_________._________- kepti w No. of compartments--------------------------Size--------------------------------Liquid depth------------------------._Capacity------ ---------------- tal. ;ielt�i Distance from nearest well-----------------Distance from foundation___________________Distance to nearest lot line---------------- is c " :; Number oflines-----------------------------------Length of each line------------------------------Width of french--.-----------.----------------"---- �o�y ' r Type of filter material--------- -__ --- Depth of filter material-----------------------Total length---.-----------.---------------.---------- t ro ndation_. - Seepage Pit: Distance to -nearest well__ —4 _Distan _.D stance to nearest lot line_____ \ {� .Size: Diameter--- --_'/------.Depth_..�%S._.!---------------- Number 6 of .pits__° _____.._ __-Lining mate al___ p: N t Cesspool: Distance from nearest .well-----------------Dista rom foundation-----------------".Lining material _..------.__----------..____________ ❑ Size: Diameter_.: ----------Depth"---------------------- ----------------------------Liquid Capacity-------------- ----- ------gals. �7 ' Privy: Distance ❑ -from ne atest well______ ________ ,_____Distance from nearest building _ __________------------------ s _____________.__ s • , _ Distance to neaot..ne; ------ ----------------------------------------------------------------- -rest �`{ -u ___.._. Remodeling and/or repairing (describe): ------ -'-----'----- ------ -------- ------------------------------------------- - 5.: = 1 -----�--------••------------------------ !-------------! ------ --- ------- -� _ ---_-- _ - --•--------- ----------------------------------------------------------- ------ ---- r ----------- W7------------------------------- -- = j -------------------------- _ _____________ ____ ___ ____ __ __ _ _ __ I hereby certif that I have pr I epared this application-and that t work will be done in accordance with San Joaquin County ordinances, St to laws, and rules..a`n� regulaptions'of fhe San a uin Lacai Health District. (Signed) l:..> r f _ l°� i 1 � �_. -------------- ------------------- 4�-- _ r Contractor) [` f. _ B ,��f,y -- - - � - ------(Title)------ - -------- ---------------------- - -------- � i. [Plot plan. showing size of lot, location of system in relation wells, buildin s,r'etc:, can be.placed on reverse side]. FOR 40ARTMENT USE ONLY . APPLICATION ACCEPTED BY----------', ,:Lm - -------- ------------------------------- ------ DATE----------1-6---<1 -------------------- --- I - DATE--------------------------------------:-------------------- BUILDINGPERMIT ISSUED--------------=-•--------- ---------- ------------------------------------------------------------- DATE------------------------------------------------------------- Alteraiions and/or recommendations:-------.__ ---------------------------------------------------------- ' �- - ' ----------------- ' ------------------ ------------------------- - ----------- -------------•-------•-------- --- ------------------- ".— --------------------------------------- ---------•------------•------•--•------------------------------_-----------• y_. -" ; - •- := ... 4 � y , FINAL INSPECTION BY: Date` - -_----------------------- :. 1 SAN JOAQUIN LOCAL HEALTH DISTRICT - r''"' 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 Saut merican Street I Stockton, California r .f Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P;Co.��'�