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f APPLICATION FOR SANITATION PERMIT Permit No. "• ' �,�• ;} �• ,.A'*w.*S, *, (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"applicatibri is made in compliance.,wifh.County-Ordinance 4o, 549. i JOB ADDRESS ANCATION : ----r ------- -------------------------- Owner's Name 2� ''`- - Phone Address-----: l-G . --------------- `zy ? .: Contractor's Name . , � ---•-------•---------- Phone ' Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court;❑ Motel Other ❑ F Number of living units: _--- Number of bedrooms _ Number of baths _/ l Lo# sized l ---------------- Water Supply: Public system ❑ Corrlmunity system Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand.❑y Gravel ❑ Sandy Loam ❑ Clay Loa m'D Clay ❑ Adob Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ . FHA/VA: Yes ❑ Ip " TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank'or'cesspool permitted if public sewer is available within 200 feet.) 1�7eptic 7 nk: Distance from.nearest welt_________________Distance from foundation---_.---------__--.Material__-_------__-_-..--.------__.__---------__--__--. L❑1�r�� No. of compartments-- ------------- -Size # --.___Liquid depth_ _Capacity 1 p Y ---------------- Disposal R d: Distance from nearest well----------------Distance from foundation-------------------Distance to nearest lot line__---_------_-_-. , �� Number of lines----------------------------- -Length of each line----------------__- t -----__---Width of trench------------------- .. --------------- ype of filter material______________-----_"""Depth of filter material----------------- -----Total length------------------------------------_- See Pit: Distance to nearest vyellz_ '_----_Distance from fo ndation_ - �Qistance to nearest lot line --. Number of its-----_�--------------Linin material,��7-_ {_-_Size: Diameter-- f f ' p g ----------Depth------�a--- ---- Cesspool: Distance from nearest well--------------------Distance from foundation.______-_.__:____ Lining materia!_-.---------------------------------- r •� Size:'Diarneter---- ------------- ------------DeFth----- = ----- ---�- ------Liquid Capacity--------------------- gals. Privy: Distance from nearest well------- ____--Distance'from nearest building � . ❑ Distance to nearest lot line------------------------------------------------•-- -- -------------------------- Remode)in .an._ or repairing' (describe):___- �- - � �'- --:------ -- --- --- - -- -----� ----------- ----- I 3 --------------------------------------------------------------------------------` ----=-------------------------------------'',? --------------------------------------------------------------- I hereby certify that;l_haye prepared this.a'pplicati an that the work will be done in accordance with San Joaquin County ordinances./$Nle laws, And rules and egul ions of t e �a Jaaqui` L'ocal'Health District: x (Signed)--- --- Com' - (Own-----------r------ -----------------------------------_ er d/or Contractor) BY: � — ��r� {Title). ... - I - ------------------- (Plot plan, sh in. ze of ocation f system in relation to wells, buildings, etc., can be paced on reverse ie). t 4 FOR DEPARTMENT USE ONLY 1 _ i APPLICATION ACCEPTED BY_�R-_ �' - ---------------- --------------------------------------- DATIr---�--"- '-' ---------- i. REVIEWED BY-------------=------------------------------ ----------------------------------------- ``---- ---------------------------- R'ATE------------------ •'4------------•------------------------ - 7 BUILDING PERMIT ISSUED------------------------------------------------------- ----------- DATE---------- ------ -------------- k ndations-------- ---------------=-------- - -------------- Alterations and/or recomme --- -------- ------- - z-T------- - _I''T H':--- �Az r -a - K 1` '^ - `L �------------------------- __ ---------------------- ----------------------------------------- ------------------- p_!- --�W� _3m-ri o�----------- - 7= -9 --------------------------- -----•------------- -------------------------- t a)vTl,a- - Y � ---------------------------------- --------------------------------------- -l. k. -._ ----- - ----- -- --- A FINAL INSPECTIOB �1_ ; - - - _ � - -- --- .:-- . Date--- SAN ate--SAN JOAQUIN LOCAL HEALTH DISTRICT 'l 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 . Revised 1-57 F.P.CO.