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APPLICATION FOR SANITATION PERMIT Permit No. ., 41 1p (Complete in Duplicate) Date Issued ------__l-7_4 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. , JOB ADDRESS AND LOCATION__.___ = � � -------------- . - - ------ Owner's Name r4 "1--------------------- ------ Phone Address_-- ---- -------------------------------------------------------------------------------------------------------------------------- Contractor's --------------- ----------- --- Contractor's Name_� ------------------- Phone.- 6- --- n units:__!._— Nu Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living ' tuber of bedrooms Number of baths I-__ Lot size ____X� ___�f_p_!�------------------ Water Supply: Public system Community system [I Private ❑ Depth to Water Table _elft. f Character of soil to a depth of 33 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeEI'Hardpan ❑ Previous Application Made: Yes El No New Construction: Yes ❑ No FHA/VA: Yes F] No 2 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ptic aD Distance from nearest well-_-'_ --------Distance from foundation-----------t------Material-------------------------------..-_------_""_-_. No. of compartments--------- -- - ----------Size--------------------------------Liquid depth--------------------------Capacity-------------- f Dls os'a�FIGI Distance from nearest weh.".�_.""___Distance from foundation__- ,----`-----Distance to nearest lot 1�in�e _} a Number of lines-------- _-----------------Length'of each line------ _�-- ;__--Width of trench--- -`A7_'---f--------------- Type of filter material__ _Cl "----Depth of filter material___._ """-----"_Total length"-______. __._-_______-__________ . F Seea � om foundation-_fa__-____.--.Distan�e�to nearest lot line___ -4_____- 6 Pit: Distance to nearest well __._______-Distance; 77 Number of pits.____------------Lining material____-__,_��€-L .Size: Diameter_- 7 -- -.___.Depth-__� ----------------- A •„ from nearest well_________________Distance from'2foundation--------------.".__.Lining material------------------------------------- Cesspool- Distance Size: Diameter-- ----------------------- ---------Depth �----------------*------------------------------Liquid Capacity gals. Privy: Distance from nearest well-)------------------------ --------------------.-Distance from nearest building---------- _____._______________-__.___ ❑ Distance to nearest lot line----------------------------- --------------------------- ----- ---- ------- 1 It Remodeling and/or repairing (describe). �_ _ --- ---------- --- �-� ---------- -;---- - ------ =------------- f ------------------------------------ ------------------------- .-------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. neck —,— (Sig }•------------------,@j�---�--- -------- --��-��=�_.�`�_��=----:� 1 -------------------------.(Owner and/or Contractor) - --------------------------(Title)------ -- 7 ----- i y' - . _ (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED ---------- ----- ------------- DATE------------ ------------------------- - -- -- BY-------- - ----------------- --------- ---------------------- ___j:1 ---------------------------- PERMIT ISSUED_ - -------- ------------------------------------------------------ DATE--------- BUILDING ------- REVIEWED BY BU I LD I NG --------- -------------- ----- - - -- =- -- ------------------------------- - DATE --- Alterations and/or recommendations:-------- ------------------------------------------------- -------------------------------------------------------------------------------- 5 - -------------------------------------------- ---- ----------- - -- --------� --=----------- - -- ---------------------------------------------------------------------- ---6-A... .- c "----------- Date-- FINAL INSPECTION BY:_-____.._ _ r 4 . SAN JOAQUIN LOC 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-7-2M , Revised 1.57 F.P.CO. /