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APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) � � - Date Issued':____ .J.> _ . 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---------- f �'� --•-------r�----,::-------------��-----_--_- ------------ Phone------------------------- -------- Address-_..---------------fY.t;rl------- Contractor's Name---------•------------------------------ - '" ------------------ Phone------------------ . ---- - �-:--- -� - - -- -------------------------- - - - -----••--------- Installation will serve: Residence A artment House. Commercial L. "T"railer ler Court- p ❑ ❑ � Motel ❑ Other ❑ Or Number of living units: __/__ Number of bedrooms __ p ____` _-- Number of baths -1___-'Lof size --_-� �.---,��Q---•--------•.--•---------.. r41 Water Supply: Public.system Community system ❑ Private ❑ Depth to Water Table ft. / Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam-E]'5 Clay ❑ Adobe &�Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ �Noj�,;--FHA/VA: Yes ❑ No 1�11 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sep f' Tank: Distance from nearest well-----------------Distance frorn.foundation--------------------Material--------------- "____________._.________.__""____. No. of compartments--------------------------Size------/----------------------Liquid depth-•-----------------------Capacity_...-------------- 1 pisp sal Field: Distance from nearest well_..._�r*_.__Distance from foundation__------p_______.Distance to nearest lot � . Number of lines---------l__ A 4 De f Length of each line------ th of filter materEal_____��_l.�.-___`�______Total len__.__.Width of trench___�_'�_______--------------- Type of filter mate ria l_j_X_,� p g th______5"o_",_-"__________:________ Seepage Pit: Distance to nearest well---- -------'-Distance fr m f nciation__�Q. _-,Distan e to nearest lot line__./49__�_ \ Number of pits'-------/----------Lining material__---Size: Diameter"__. � Depths�� '__ _____________ \ Y C� Cesspool: Distance from nearest well--------------r`Distance from foundation-------------------f material------------------------------------- Size: Diameter �[❑ Diameter_________-___- ------- --------- Depth Capacity_---------------------------gals. \ Privy: Distance from nearest well_________________ _________________.._____.-.--Distance from nearest building_________.__________________________._. ❑ Distance to nearest lot line....'�------------- - -- - Remodeling and/or repairing fdescribe)---------------•----elf -- - , - s ) ------------------••-------------------------------- ------------------------------------------ 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 an4 regulations ol the San Joaquin Local Health District. (Signed) ------------------------------------------------------ By: * t � Contractor]-------- ------------------ $ , __21-4k, f------- Title �l -- (Plot plan, showing size of lot, location of sy in.relation to wells, buildings, etc., can bes placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------moi--'- --------CD ----------"---------------------------------------------- DATE----------- � - REVIEWEDBY--------------------------------------------------.----------------------------------------------------- ----- DATE----- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations., ----------- -------------------------------------------------------------------------•----•-•-------------- Its ----------------� � tt------ lAl-rte ---7----C0NAJ.F_CT_I_Q -- ---------- .. �------ ��uA_�- - ------- ------------------------------------------- -------------------------------------------------------------------- ------------------ --------------------------------- --- - ----- -- ------- FINAL INSPECT BY:. Date--- -- V--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT �. 130 South American Street 300 West Oak Street 'i32 Sycamore $+ree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2A4 . Revised 1.57 F.P.Co_