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APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in Duplicate) s bate Issued --7, f 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 7No. 549. � JOB ADDRESS D LOCATION------------ r "" L d, - --- ------------------------------------------ ------------------------ --------------------------------------- Owner's Name + -- ------------------- ------ Phone------------------------- ----------------------------------•-----------------------------------------=--------------------------- Address-----------------------------m--Contractor's Name------------------- ---------------------------------------- -- •------------------- -------------------------------------------- Phone------------- --- ----------------- ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of livingunits: _-7.__ Number of bedrooms r C- -• --- Number of baths _-d---- Lot size -_-- ---� - -- - 6 ----------------------- Water Supply: Public system ;k Community system ❑ Private ❑ Depth to Water Table.3-4__'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @R--Hardpan ❑ Previous Application Made: Yes ❑ No-jg.- New Construction: Yes ❑ No;�FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or`cesspod3 permitted if,public sewer is available within 200 feet.) �/� Septic Tank: Distance from nearest weld-141`Distance from founds ion__ _ __________Mate l-. _---------- -------------------------------- ---------------- ------_ .---•t'GL-__-___----_______-_. No. of compartments----v .-------+--_-4'S' e--- -_- _--- --�C Liquid depth______ -- aci - ------ p_ ty---.F�-�--- Disposal Field: Distance from nearest we -I-_tv istance from foundation--/-Q- --_-.Distance to nearest lot Number of lines------�:_tk4`--- ----_-- --Lendth of'each Brie=2 �---�f r5'"'-Sf�-.�11/idth of the>i�h U- --- -------------- n Type1 . fif.ter'material.__ yk- _ ._-- eptheof filter material'__ _-_--__-_--Total - �' i � .s i � st r � Seepage Pit: Distance to,nearesf well--W�(-A---Distance from foundation__x _-_.D,istance to nearest lot line--_ Number of pits"'` ---_.---_____Linin material- T - Size: Diameter- ' OdO A f g ` u't-d e+c b & ---.Depth-----� f ------------------- Cesspool: Distance from nearest well---------------- Distance rom foundation..__--___-----_---..Lining materialF------------------------__--------- ❑ Size: Diameter------------------------ -------------Depth----------------------------------------------------Liquid Capacity- .------------------------gals. !! �I� Privy: Distance from nearest well------------------ --- -__--....-Distance from nearest building--____.-----_____----_---_____-----____-. (� ❑ Distance to nearest lot line--------------------------------------- Remodeling and/or repairing (describe)----------------------------------------------------- ------------------------------- ---------------- --------------- • 1 j --------------------------------------------__-_--_-__--_-_-----_-_-- ._--__-_--_-__-----_------_-_..--_---_-_---.-____--------___-----__-_---_--__- --_---_---__-_--__--__--__----_----- -.__-____-----._--____-- 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 regula ions of the San Joaquin Local Health District: r % (Owner and/or Contractor) (Signed) •-------- ---------------- - -- - ----- - ------ --------------------------------------------------------- RY� ( -----------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be`placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --_----- . -.-. ---- DATE----_------_-_ REVIEWED BY - ------------ - -- - - --- ----------------- DATE-----7-� -- - BUILDINGPERMIT ISSUED------------------------ ----- ---------- -- ----------- ---------------------------------- DATE------------------------------------------------------------- U ----------------------------- ----------- ----------- Alterations and/or recon dation :--- __ ___ ________ � _- _ --------------------- --------------------------------------------- - - - - - ------------------------- i ------------------------------------ ------------------------------------- -------------- ---------------------------------------------------------------------------------------------------------------------------- I ------------------------------------------------------------------------------------------------------ ------------•------------------------------------------------------------- FINAL INSPECTION BY:. .Z_?_ - ------ Date-------//-`--- =!_----. SAN J AQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F,RCO.