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APPLICATION FOR SANITATION PERMIT ' Permit No. _I_[._a _`f__ (Complete in Duplicate Date Issued ---1.`-Vis_-�_ Application-is hereby made to the San Joaquin Local Health District for a p t nstr ct,and i all th work herein described. This application is made in compliance with County Ordinance 1, 549. JOB ADDRESS AN ATI --_- Owner's Name--------- --- ---- �- - •=- --------- - --------------- ---------------------------- ------------------ Phon , Address-------------_ ' Contractor's Name--_--.-- -- -- ------ - --------------------------------- ----------- ----------- -------------- - --` Phone- -----•---- -----------•--------- Installation will serve: Residence Apartment House E] Commercial [ITrailer Court [] Motel Other ❑ Number of livingunifs: _-. - Number of bedrooms // _--- Number of baths __�--_ Lot size -L_�� - ---- ---------------------------- -------------------- Water Supply: Public system Community system ❑ Frivete ❑ Depth to Water Table --_ift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam E] Clay [] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No I?/ New Construction. Yes F"No ❑ FHA/VA: Yes F No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or"cesspool permitted if p 6 c sewer is available within 200 feet.) Septic ank: Distance from nearest well_--- �Disfanc from fou dation-----A9----_-_--Mater'aIF__ ----------- of compartments----- - Size___-- -- -_-__- __:___Liquid depth-_-__- ' - - Ca aci [}_____- ----- + p Dispos I Field: Distance from neares well _- M.R•PSisfance from foundatio - r_ - - Distanceito nearest b line----------------- L Number of fines---- Length sof each line------�-- - - ------Width of trench-_� Type of filter mafer-ial= _ -_-Depth1of_filter.material-`�_.-_ r Tota€._length- Seepage Pit: Distance to nearest well-- --------------------Distance from foundation-------------------.Distance to nearest lot line--------_------- ❑ Number of pits---__---- g Linin -�r'D stanlce f Size: Diamefer •-----------------.Depth �i� Cesspool: Distance from nearest well-_*- from foundation--------------------Lining material--------------------------- ❑ Size: Diameter------------------------- -�- �Deo'th------I-------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----_--------------------------- --------------Distance from nearest buiidin ❑ Distance to nearest lot line--------------------------------- Remodeling and/or repairing (describe)---------------------- ------------ l •----------------•-------•----------------- -------------------------------------------------------- i - t ------�--------- ----------------------------- - ---------------------------- ----------------------------- --.�._�---- ��.�=------------------------ -------------- I hereby certify Wat I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- - - -------AU' __-_______(Owner and/or ontract $Y� --------------------------------------------------------------- Title - ------------------------------------------------ ---- ---------------------------------------- (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). E FOR DEPARTMENT USE ONLY APPL REVIEWEDON BY--ACCE�PITED BY -_ — __ - " DATE BUILDING PERMIT ISSUED Alterations and/or recommendations--------- DATE ---------------------------- -------------------------- ----------•----------- ----._.--_.- --•------ t J._a - j( e ------------ --•---=------- ----- - ----------------0__ P- FINAL INSP N ---- - ----- 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 ES-9-2M , Revises 1-57 F.P.CO.