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APPLICATION FOR SANITATION PERMIT Permit No. - d• �G (Complete in Duplicate) E. Date Issued I ��---- I Application is hereby made to the San Joaquin Local Health District for a permherein described. it to construct and install the work This application is made in compliance with County/Ordinance No. 549. � \�-e___- JOB ADDRESS AND LOCATION_ ____-- _ _ _I__ -------`tel �� Owner's Name----------I' Sa _ _1''_1�-7--------- --------------------------- - Phone- Address ---------- ----------- -- ----- - Phone- -- --------- ------ �-�- Address----------------- Contractor's Name--. - - ��--- -- -�ct-h -- - --------q!;>-,--Tl -- ---- - -�-�°--------------------------------------------- Phone.: - Installation will serve: Residence P56 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms __k Number of baths __/_ Lot size __._ t, -- .- ------------- p, Water Supply: Public system [ Community system .❑ Private ❑ Depth to Water Table 1 Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sand Loam Clay Loam Cay� � Y ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No DK New Construction: Yes ❑ No X FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) S S ti ank Distance from nearest well_________________Distance from foundation____-_ No. of compartments-------------------------Size--------------------- ---------Liquid depth-------------- -------- Capacity----- ---- - - -- D'poll F Distance from near st weUO _pistance from foundation__ _0_� Distance to nearest lot line------------------ Number - Oy"A �� of lines__ -------.-I.___ _-Length of each line__-_(`- -------- -Width of trench---- did - Type of filter mat erial_ i�_. � Depth of filter material__-_ ,Q�`______Total len th________ `1 +� 9 G�Q------------------------ Seepage Pit: Distance to pnearest well _ Distance to nearest lot line______.`- Distance fro foundation-4P-„•--__, Number of its_-_�________________Lining material. lt'k---___-----Size: Diameter_--6..`- r Number - - ---.Depth__�---------- ------ ' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- materia) ---- ❑ Size. Diameter ------------------- -----------Depth--------------------------------------------------Liquid Capacity ----------- gals. Privy: Distance from nearest well__..1___________________________ .............__Distance from nearest building------------------------------ Distance to nearestRemodeling and/or repairing lot line______._________________________.- ---------------------------------------------- - - --- - p g ( escri e) ---------------------------------------------•-- -e -ell ------------------------------- ---•---------------------------------1-- ----------------•---------------------- ------------------------------------------------ ' -----•--------•-----------•------------------- -------------------------------------------------------------•------------------------------------------------ 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 ands regulations of thaAan Joa uin Local Health District. {Signe - -- -11f r F f - ---------------------------------------------- Contractor By----------------------------- ----------------- ---------•----- I---------------------- - --- --------- - - - - ---- ----------{Ti+lei-------------------------------- ------ ------------- ----- - - ------------------- ot plan, showing size of lot, location of system in relati o wells, buildin s, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --•------------------ ------------------------------------------ ---------------------------- DATE REVIEWEDBY -------------------------------------------- - --- DATE BUILDING PERMIT ISSUED-- ----------------------- -------------- ------•--------------------------------------- DATE Alterations and/or recommend a+ions:_ ------- __ _____ _ __ ------- ---- ------ - ----- - ---------- -------------- --------------------_---- ------ -�---.-------------------------------- --------- = _ - - - ----- ---------' •--------_----- -----------------------------•-----------------------------•------------------•-------------.--------------------------------- -�--.1- ---- _v--__- - --- -------tiJr--- ---------- III ______-_. ________________ ________________________________________________ _ _ FINAL INSPECTION BY:_________ _ __ ___ __ -- • - ---------#-- ---- Date----------��----�G--�--� 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 E5--9-2M . Reviseal 1-57 F.P.CO.