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APPLICATION FOR SANITATION PERMIT Permit No. 2-7. Date Issued A� (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Disirict for a permit to construct and install the work herein described. T2 application is made in compliance with ounty Ordinance No. 549. - - - ------- ------ ------- JOB ADDRESS AND LOC 10 P ----- ---- Owner's Name__________ ----- ---------------- - - ----------------- hone------------------------------------ Address-------- ----------- ------------ -- ------------------ ----------------------------------------------------------------------I----------------------------------------- Contractor's Name--•---------- --- Phone----------------------------------- Installation will serve: Residence P-:Apartment House,0 Commercial 0 Trailer Court [] Motel C] Other [] Number of living units: Number of bedrooms -S-- Number of baths/;y_ Lot size -------------------------------------- Wafer Supply: Public system Community system El Private �epfh to Wafer Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El Clay Loam E] Clay ��Adobe [] Hardpan C] Previous Application Made: Yes E] No 1771 New Construction: Yes El No 0 FHA/VA: Yes ❑ No E:1 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_,_%r If-Distance from foundation__. __ ---Mate ri,l No. of compartments---+F--- ----------------- ----Liquid ----------Capacity---r->'V------- Disp I Fi id Distance from nearest well__O..�------Distance from foundation___1Y---------Distance to nearest lot I;ne__ZA:1------- Number of lines______ ________________________ ------------.-.Width of french---- ---------------- -------------------------J&ngth of each line eo Type of filter material__/_-`0- eptln of filter material----Ar----------Total length------yc�------------------------- e Seepage 6_______Distance fr9m foun46 cam_____ is well-__ anv to nearest [of line___®____-_ -Pit: Distance to nearest ----.----------.Depth-----. --------------- gel Number of pits------/-------------Lining materlal_/jt_#44�_ ize: Diameter__�� -----------Depth Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_..________.____.____._--_--______. ❑ aterial------------------------------------- T_l Size. Diameter-------------------------- -----------Depth--------------------- ------ ----------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.------------------------------ Distance to nearest lot lire----- e---------i--------LAL-------------------------------------------------------------------------------------- ❑ 01 -1� -------------------------------------------- Remodeling and/or repairing (describe):_ -A/- -Z--- ----- ------ ---4- ----------,-------------------------------------------------------------------I------------------I----------------------------------------1----------------- ------------------------------------------------------------ -------------------------- ----- -------------------------------------------------------------------i------------------------------------- ---- ------------------------------------------------------------------------ --------------------------------I---------------------I---------------------1--------------------------- ------------------------------------------------------------------ •------•-•------------------------------------- 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 re ulations off the San Joaquin Local Health District. . ........ . - -------- (Signed)------ . .... . __�-----------------------------(Qwoei m- Contra for) ------------------ - - --- ----- -------------------- ------ By:-------------- ------------------- -- ---i - ----------------------------------- • (Plot plan, showing size of lot, ation of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------- - ---- ------------ DATE - F----.5.. - ------------------- REVIEWEDBY------------------------------------ ------------ ---- - - - DATE------------- BUILDING PERMIT ISSUED---------------------------- -- - -------------------------------------------- ----------------- ----- DATE----- ------------------ ------------------------------- _Alterations and/or recommendations:__._ ---- ---------------------------------------------*------------------------- o ----------FIT-----ht.L-A......... ------------------------------------------ ------------------------------------ ------ ------------- —--------------- art -------------------------------------------- ------------------------------------------------------------------ ----------------- --------------- ------------------------------------------------------------------------- --------------- ------------------------------------------------------ --------- ---------I------------------------------------------------------------------------------------------------------------------------------- .e Date--------------------- --------------------------------- FINAL INSPECTION BY:-------- ----- ------------------------ 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 Revisea 1.57 FY,CO.