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y APPLICATION FOR SANITATION PERMIT Permit No. .. �7--�_ _ (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 described. This application is made in compliance with County Ordinance No. 549. �� I , /- ---. � JOB ADDRESS AND LOCAT in ` Phone----------------------------------- Owner's Name �l-L µ ` 1 Address--- ----- ------------------ --------------- ---------------� -----� ------------•----------•-------••-------------- Contractor's Name------------ - _ ------------ Phone__.-------------•-------------- - • -- ------ - - -- ------------------ Installation will serve: Residence Elpart ent House ❑ Commercial p Trailer Court 0 Motel [3 Other E] _rNumber of bedrooms _-q Number of baths ._f__ Lot size __ I�_l/1"____. _ -- ----•.------- rumber of living units. -/_4r� Water Supply: Public sy4 stem Community system ❑ `Private ❑ Depth to'Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&-pardpan ❑ Previous Application Made: Yes ❑ No[�New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or''mcessp ol,6ermitted if public sewer is available within 200 feet.) istance from foundation____________________Mater-alp_____________--._____..___ 1 Septic T k: Distance from nearest well_n }' - �7' �/ ( -- _Lic{uid de th---- Disposal of compartments Size ` p. -- -------------Capac:tY . -- -- -------- Disposal Field: -Distance from nearest, well-A47>1,-�- istance from foundation__/ ---------Distance to nearest lot line---.`?___ ----.Number-of line's____.-/--------------p- -- Length of each line_____A�-----------------Width of trench----o -` ---------------------- Type of filter material _ _/4_AVzeDepth of filter material_ rJ ---- length-----. ____________________ 'L��"' " p Seepage Pit: Distance to nearest well____A --- _Distance from fou ation____! _______.Distance to nearest lot �ine___P-___ ____ Number of pits______ ____________Lining material Size: Diameter__-_r��:�--___-Deptn------��T�_l_--__-__._ Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----____--_.__._________________--__El . Size: Diameter-------- ---------- -----------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from-nearest well------------------------------------------------Distance from nearest building----------------------------------------- ❑ + Distance to nearesf lot line-------------------------------------------- R:c � o � Remodeling and/or rep ring (d c_ribe)A------- -- _ -- --- ------------------------------------------------------------------------------------------=. �1 --------------- ----------------- --- - -- --_-------------------------------•-------------------------- - --•------- ------------------------------ ---------------------------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Loc 1 Health District. CContractor( (Signed)-.------------------ --•- - ------ ---------- ---------------------------------------------- Title---- -- - - - --1---.----- (Plot plan, showing size of lot. Iota of system in relation to wells, buildings, etc., can be placed on reverse e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_-� -- --------------------- -------=------------------------------------------------------ DATE --------------------------------------------- REVIEWED BY--------------------------- ----- --- DATE--- -----------•------------------ ---------------•-- BUILDINGPERMIT ISSUED--------- ----------------=-------------------=------------------------------------------ DATE.. Alterations and/or recommendations:-----................................ ------------------------------------------------------- ----------------------------------- ---------- -------- ---- = - ---------- -----------------------------------------------•----------------------------------------------------------- ------------------------------------------------------------------------ , ! I _ _ FINAL INSPECTION BY:------- ---------- -------- ----- Date `` �` SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street q Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 F.P.CO.