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,1A� ! E APPLICATION FOR SANITATION PERMIT Permit �� (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Distri This application is made in compliance wc�ra permit to construct and install the work herein described. h County Ordinance t)I$a _ �'t�- JOB ADDRESS ADDRE55 AND LOCATION --------- --------------- ------U-----_-!- ` -----�----------�---'`.-j --------- , -------------------------- ---------- Owner`s Name----------aF ------ -•---------------------------------------------------------------------------- Phone Contractor's Name___________ i_,____ _ //.� r� -- �----- -- - ------ ------------------ _ Phone.,_@__90 f I Installation will serve: Residence ❑ Apartment House El—,Commercial Co mercial Trailer, ourt ❑ i Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number of bathssize ____s_______________________________ ---------------------- Water Supply: Public system Community system ❑ Private ❑.f Depth'to Water Table tYft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ ;lay [3 Adobe Hardpan El. Previous Application Made: Yes E] No New Construction: �Yes�[s4—t5o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or'cesspool permitted if u61ic sewer is available within 200 feet.) Septic T k: Distance from nearest well______ __ _____Distance from foundation__/Q---r__M au - L'r No. of compartments------- ----- ------Size_`$7k----------------------Liquid depth-- •_f,/risl� 4 ------- --------------•---------------- --p ----- Capacity �`a'P6z-- 5- Disposal geld: Distance from nearest wel�� Distance from foundation__ —/� ..U_____._.Distance to nearest lot line_____'_ _ __ __... Number of lines________f_______________ _------Length of each linea_. - t-� Width of trench.__ Q�r_`.'----------------- Type of filter material55_� _Depth of filter material-----�_y`. � ._..-Total length--______9_ __S+_�_________________ �! Seepage Pit: Distance to nearest welf-------------- ------Distance from foundation--------------------Distance to nearest lot ❑ Number of pits----------------------Lining material---_-------------------Size: Diameter------------------------Depth-----------.------------ Cesspool: Distance from nearest well----------------- from foundation-----------------.- Lining material__.___--__.__._____ El Size: Diameter-------- ------------------------------Depth---------------------------------------- ----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___----------------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe)____________________________ ------------- --------------------- ------------------------------------------------------------- -------------------------------------------------•---------------------------------------------------------------- --- -- I hereby c ify that I hav pared }his application and that the work will be done in accordance with San Joaquin County ordinances, St to awl and r e an regulations of the San Joa in Local Health District. Si ned rr ( 9 )--------- --------------- ------ --- --------------- (Owner and/or Contractor) By:-------------------------------------- •-§� {Title) -} - - --- - --- -------------------- (Plot plan, showing size of lot, io ation of system in relatio o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ _______ DATE _ -------------------------------------------------------------------- DATE BY DATE------ ►�� --------------------------------- UILDING PERMIT ISSUED------------------ ----- --- -------- -------------------------------- ------- --------- DATE--------------- ------ ------------- - ------------- ----------- -- Aterations and/or recommendations-------- ----- ------------------------__ ; ------------------------------------- FINAL INSPECTION BY:----- GLV, --------------------------------- Date--- -- D SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised 1-57 F.P,CO.