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APPLICATION FOR SANITATION PERMIT Permit Na. ✓" �7 I' (Complete in Duplicate) V ' Date Issued _____�'� d A lication is hereby made to the San Joaquin Local Health District PP Y q h s rict for a permit to construct and install the work herein described. ` This application is made in compliance with County Ordinance No. 549. r-:;7 li JOB ADDRESS AND LOCATIO 311 W ------- ---- ---- ✓ ---------------------- ----------------------------------------------------- ------------------------- Owner's Name!!__ -•------------ ------- --------------------------- Phone 3y3a - , • Address1 --------------------------------------------•----------------------------------------------• - Contractor's Name___ d Installation will serve: Residence ,9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L, Number of bedrooms _.,?-- Number of baths ----I-- Lot size _ a� _ _ _�__________________________ Water Supply: Public system Uk, Community system ❑ Private ❑ Depth to Water Table ys ft. Character of soil to a depth!Iof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.® Hardpan ❑ Previous Application Made: IYes ❑ No R� New Construction: Yes [] No ❑ FHA/VA: Yes ❑ No JZ 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-----------------Distance from foundation--------------------Material-------------- -----____..______--_-...___--__--. ❑ No. of compartments------------- ------Size---------------------------r---Liquid depth--------------- ----------Capacity-•------------ ------ , Disposal Field: Distance i! 1 p ,from nearest"weil_ 4__:_Distance from foundation___�_�__---------Distance to nearest lot line__-o______._ Number of lines______-_---- ------- of each Line---t�a__________________Width of +rench.___�.�/___��---____-- pl, Type of filter materia@-Vii.------__-Depth of filter material__1B_"__-_--------Total length___. ____________________________ ' Seepage Pit: Distance:ito nearest well_a�A�t—.----Distance from foundation_ Q_..________.Distance to nearest lot line__-cam - �__..._ iamNumber of pits___._I--------- Lining material____ _c � __ Size: Deter______ ---- ------ De Depth �--------------------- Cesspool: ------ Cesspool: DistancJfrom nearest well--______________Distance from foundation____________________Lining material------.__________________._________ ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance-from nearest well-------_-------_---------------------------------Distance from nearest building------------------------------------------ F1Distance-fo nearest lot line-- ------- -------------------------------------•--------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)-------------- ----------------------------------------------•-------------------•---------------------------------------------------------------•--- --------------------------------------------- ---------------- -------------------•----------------------•----------•--------------:---- -------- ---------- --- -------- - -E- ---••-=----------------------------------------------------------------------------------------•-----------•-----------------------------•---- ----------------------------- Ihereby certifythat --ave 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. (Signed)----------------- AAJILa- - �----- ---------------- --------------------- ----------------- ----------------------------- - - - (Owner and/or Contractor) By' 'i-------------------- --- -----------�---- - ------�-----------------• --------------------- (Title)_ (Plot plan, showing SEZB Of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----__ ,F --`------- ------- --------- -----------------------------•----------------- DATE--------- - REVIEWEDBY (M-------------------- ------------------------------------------------- ---------------------------- DATE-------------- BUILDING PERMIT ISSUED-A-----------------------------------------------------------------------------------------------. DATE -- ---------------------------- Alterations and/or recommen`ld` ations:------------------------ ---------------------------------------------------------------------------------------------------------------------------- -------------------------- •-------- ------ --•--------------I-----!"---- -------•------------------------------------------------- '`' `- = ----- _------ = -------------------------- ------------------------------- - -----------------------•----------------------------------------------- --------------- ----- -------------------------------------------------------------------------------------------------------- ---------------------- i ----------- -- ---- ------------------------- R i Lf------ ---------• ----- 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 1 , ES-9-2M , Revised 1-57 FIP,CO. i�:� ;i 1