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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrKed. This application is made in compliance with County Ordinance No. 549. 4 Y"--------------•---- JOB ADDRESS AND LOCATION--- -_ / P —------------- Owner's Name-------- ------------- ---—----------------------------- - ------------------------------------- Phone---------------------- ---------•---------------- -Ir------ -----------------------------------------------------------------------------------------------*------------- Contractor's Name---------- d, . -7 ------------------ Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel [] Other E] Number of living units: --/Number of bedrooms _Z_ Number of baths --/-- Lot size -------71S ____X____,;7_j_,-__.e------------- Water Supply: Public system Community system Private E] Depth to Wafer Table 00 ft. Character of soil to a depth fffeet: E] Private Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay El A Hardpan El Previous Application Made: Yes E] No kNew Construction: Yes E] No FHA/VA: Yes ❑ Z�K N�A TYPE OF INSTALLATION AND SPECIFIC (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) epti „�a�fj Distance from nearest well_________________Distance from foundation_________________-_Material______.________________________________________. l No. aterial---------------------------------------- No. of compartments- -----------------------Size--- .--Liquid depth------------------------- r)<1/D 2.e'ield ------------------------- j: Distance from nearest well---W�/JI:Qisfance from foundation----/,j0________Disfance to nearest lot line---:S��-------- Number of lines___.-___ _________ __Length of each line------- ------�Wiclth of french-------- Type of filter material____ �0%_2f_Depth of filter material______ length---____2_ -----or--------------- seepa Pit: Distance to nearest ell--- Distance f foundaf ion....e, �� I �" 17 _0----------Distancp-jo nearest lot iine__,=�o--------- jNumber of pits-- ------------------Lining material----- �_Ge__Size: D ia meter_ ---Depth___!;P��------------ .5spool; Distance from nearest well-----------------Distance from foundation--------------------Lining material__.________________________________ ❑ aterial------------------------------------- E] Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building______.____________________ ❑ Distance uildin9-----------------------------Distance to nearest lot line------------------- ----------------------------------------------------------------------------------- ---------- ------------- and/or re airing (describe):__C;_:: ------C:2L------ ---- ------- --- ........ ------------ ------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------ --- ---- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------- I hereby certify A l have prepared this application and that the work will be done in accordance with San Joaquin County I ' ordinances. State law i -d rules ancIregulations of the San Joaquin Local Health District. (Signed)---------------- ------ 4Pwner and�or Contractor) 6 - (Title)------ By:-------------------- ----------------------------------- (Plot plan, showing size of lot, location of system in relafion.,,:tc, wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------- ----------------------------------------------------------------------- DATE--------- APPLICATION ACCEPTED BY----- - -_1.-F\-0 V REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED------_--------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:--------- - -- -- ----------------- --------------------------------------------------------------------------------------- -W ;P K--------------15- ------------------- ------------I-- --- -------------�M_ --------v --- --- --ll� --------4-- --- ---------2-- ------------------------------------------------- ------------------------------------------ -------------------------------------- ------------------------------------------- ----------------------------------------------------------------- ---------------------------------------------------- ---------------------------------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------- ------------------------------------------------- E- - --- -- ----------------- ---- -------------- ---------------------------------------------------------------------------------------------- q FINAL INSPC�TION BY: ---- --- cz� Date_--------- a� SAN ate----------- 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.;'.CO.