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/14 APPLICATION FOR SANITATION PERM T, '� Permit No. ----- Q �` (Complete in Duplicate) 1i �' y-•q Date Issued --- 1 Application is hereby made to the San Joaquin Local Health District for a per itlo construct and install the work herein described. This apps[cation is made in compliance with Countyinance No. 549. JOBADDRESS AND L C�TION_:4 --_�----------------------------------------------------------------i- }*Z-------------- or Owner's Name------�` ------- ................. - ------ ...... Phone------------------------- JAddress-------------------------------------------------- 4t �f4 / Contractor's Name------•---------- f�� _H---sem- _. __ Phone... ------ Installation will serve: Residence DM�, Apartment House E] Commercial E] Trailer Court E] Motel E] Other Ell Number of living units: __/____ Number of bedrooms___- Number of baths ____�__ Lot size ---!-d.�_`_,�--•�-Com_©................. Water Supply: Public system-iltCommunify system ❑ Private OK Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel C) Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No J—New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fanV or'cesspool permitted if public sewer is available within 200 feet.) f Septic. Tank: Distance from nearest welLDista e from foundation___�Q_______.Material- � "_ �_____-___. = Liquid depth ------- No. of compartments-_67—___.- ___Size Capacity__ '_ Disposal Field: Distance from nearesf well_IrQ. .__Di ante from foundation__X._6___e_�.Distance to nearest lot lirfe_xr_ Number of lines ___. _ __. _ Length of each lin ---.Width of trench------.`�_y-.________ jj Type of filter material-__,.` -- _-_Depth of filter material..... ............Total length--- See e Numb -- - ------------- Cesspool: Distance from nearest well-_____-___-____Distance from undation___-----------------Lining material___.___-__-_--- __-._______________- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity -------gals. Privy: Distance from nearest well _______------------------_----------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------------------------------- ------------------------------------------------------------------- Re odd lin and ol,repa" a g (desc be): , -- �s�` '�� --- --- - --------- -- -- -------- ----4z ; E ------------------------------ I hereby certify that I have prepared f • pplication and that the work will be done in accordance with San Joaquin County ordinances, Sta . w and rules and re at' ns of the San Joaquin Local Health District. (Signed)----- -- -- -- - ------------------Znrelafion ------------------------------------------------------------(Owner and/or Contractor) By: (Title)_ (Plot plan, showing size of lot, location of syste to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -------------•------------- DATE----- --------------- REVIEWED BY----------------- --------------------- - -------------------------------- DATE---- BUILDING ATE--- I BUILDING PERMIT ISSUED----------------------- �--------------- ---------- - ----------------------------------- DATE------------------------------------------------- e ------------ --- -------------------------------e tion d/or r ommendatio -------- f✓/� --------- -- --- - _ -'- --• -------- - --� - - -- {-�-t~------- -- `^ Y"* ---rFi"�---s` - ------ - �,t` -----:-------------------------------- ---- ---• ----�� --- ----------- - -----------•---------- ----- - - -£--- - �--- %.----- ------�- �.• �-------- ------------ --�-- - ---�---- ---�0 - - rid-- ----------------f- ------ __ FINAL INSPECTION BY:------- -------------------------------------- Date----------- q--- zi- - 1 - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 Rev'ssea 1-57 F.P CO.