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r APPLICATION F OR SANITATION PERMIT Permit No. (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 P o. 549. JOB ADDRESS AND LO ATION-i___--W-1;7 i ----- ----- Owner's Nam - ----- • ----------------------- - ------ ---- --------- - ---------------- ------------------------------------ - f r Phone -- f Address ` C,a ------------------ -- Contractor's Name------.-- x- /i-- - --- -------------- ----¢- -- ---- -- Phone. Installation will serve: Residence ❑ Apartment House ❑ Commercial El Trailer Court [j Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------!�7 __--__---_- ------ --- ' Water Supply: Public system ❑ Communifiy system ❑ Private eDepfh to Water Table -/ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes L< 1vo ❑ New Construction: Yes ❑ No R--'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer.is available within 200 feet.) pti Tank: Distance from nearest well--'------_-__--Distance from foundation-------------------.Material --- .-_-__-_ No, of compartments---- -------------- ------------- I I Liquid depth ------------Capacity---------------------- o- ield: Distance from nearest well--------------- Distance from foundation--------------------Distance to nearest lot line--___--_-_.----- Number of lines-c-_---____-_-------_--_------Length of each line--------------- Width of trench-- -------------------------- Type of filter material------------------------Depth of filter material-----------------------Total length-------------------------------------f fi Seepage Pit: Distance to nearest well /00----------Distan om cundation___--7 •�__.pistan�e to nearest lot line--_`5_ [ � Number of pits_ ----------- ------Lining material- ' --"-- ----Size: Diameter-_-- -- Depth---. Cesspool: y � o -�--- --- P 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 nearest lot line--__"----__---_-__..--___-.--__ -------------------------------------- Remodeling and/or repairing (describe):_------------------------------ �L !o --- - J_-e . ----------•------------------------------ �� -- ----------•---------------------------------------------------------------- Aereby certify that I have prepared this applicati6n and that the work will be done in accordance with San Joaquin County ordinances, S a lawwss and rul nd reg ations the San Joe uin Local Health District. (Signed)-- (�/ ' B . � -Owner and/or Contractor) y -- - - ------------------------------------------------Title------- 1 Ian, showing size of lot, location � (Title) � ---------------------------------------------- (Plotp 9 # of system i elation to wells, 6uildings, etc., can be placed on reverse side). d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------�A_ r � DATE �1 `-----`--------- -------- DATE - ----------- BUILDING PERMIT ISSUED----------------------------- --------------------------------- -- ------------------------------------ Alterations ----------------------------- - --------------------------------- D Alterations and/or recommendations------------- --�- �--------- ---------- ----------- ---- ------------ --•-------------------------------------- --------------- --------- ------- ---------- -- - ------ - 3--- 1 `- ---•----- ----------- -------- ---------- ---- ---- -- - ----- u /o - ----,a------ %>!Cd7G�C v--- --- --- -------------------- ls� FINAL INSPECTION BY---------- Date---------- 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 ES---7-21x1 Revisea 1.57 FRCO.