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r 4& APPLICATION FOR 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 No. 549. JOB ADDRESS AND LOCATION--------------/--4/-4-71---S;-------------- ------ --------------------------------------------------------------------- ------- Owner's Name--------------- ------- ---------------------------------------------------------- Phone--A'�)----6------ Address------------ ---------(:�,----------Ox -6v----------------------------------------------------------------------------------------- ----------------------------- Contractor's Name---------------------- ---------------------------------------------------------------------------------------- Phone----------------------•----------- Installation hone------------------------------- Installation will serve: Residence M" Apartment House E] Commercial F] Trailer Court 0 Motel E] Other E] Number of living units: Number of bedrooms --yNumber of baths Lot size ---- X-4--Cn------------------------- Wafer Supply: Public system [Community system El Private F-1 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet e'Sand [:] Gravel E] Sandy Loam P- Clay Loam E] Clay E] Adobe [BHardpan 0 Previous Application Made: Yes g No E] New Construction: Yes 5TI, No E] FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weII9)6 Alo--Disfance from foundation---ZO...... ----------- ANo. of compartments-------;—--------------Size---/0---- Liquid depth___-__----:�-____________Capacity---/?0---0----- Sispnm -Field: Distance from nearest Distance from founclation--J-02 __-__Distance to nearest lot line--4.......... K1,)0ii Number of lines-----------/---------------------Length of each line----------?,-r------------Width of trench--- --------&i--------- tro 1,1 0 Type of filter material___----------------------Depth of filter material-----------------------Total length_____-*--------------2-------------------- Seepage Pit: Distance to nearest well---'710- �Diisfance from foundation -�- Distance to nearest lot line___1�1-i------ Number of pits-------I------------Lining material-_Ae-X-------Size: Diame4er-O/Z-4--------Depth--------;:�O. ........... Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.1-ining material-------------------------------------- ❑ Size: Diameter------------------------ Depth---------------- ----------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_____________________________________________ Distance from nearest building____.__._____________-_-_...___._______--. '*� ❑ uilding-------------------------- ---------- ElDistance to nearest lot line----------------------------------------------------------------------- -------------- ----------*------------00------------------------- Remodeling and/or repairing (describe):--------.- ------ --—----. e!_-4/Z Z_' -e-0 ------------------------ �4----- ---------- ------------------------------ Zft: -------------------------------------- --------- - ----------V---------------------------------------------------------------------------------------- ------ 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 regulations of the San Joaquin Local Health District. (Signed)--------------------------------------------------------------------------------------- --------------------------------------------------------------------------(Owner and/or Contractor) By:---------------------------------------------------------I-------------------------------------------------------------------------(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---------------------- ----------------- ---- - ------ - --------- REVIEWEDBY------------------------------------------ -------------------------------------------------- DATE------------- - - - --------------------------- ---- BUILDING PERMIT ISSUED------------------------- ----------------------------------------------- DATE-----------1-0------------------------------------------- --9--------- - ------------- and/or recommendations:---------------------------------------------------------------------------------------------------------------------------...... ------------------- -e -----------R, -7A -------------5---- ------- ----------- -------- --------- ------------------ ----------------- - - -------------------------------------?E------- ------ -------lal-c-- ------ !,17--------- ------------ ------ - ------------ -- ----- FINAL INSPECTION BY:-.----_t- ------ --------7 --- ----- 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-9-2M Revises 1.57 F.P,CO.