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APPLICATION FOR SANITATION PERMIT Permit No. -- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued .______��lG_ 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 OrdinW anceeNo. 549. JOB ADDRESS AND LOCATION. .-:-- 4_---7------------1 -------------- .- IO Owner's Name ------------- !--G(--...--err' G�4i— ------ Phone -----•---- ---------- ---•----------- Address •�°R_'_1_ �--i -•-•----------------------------•----------------------------------- ••-----------------------------------•----------------------------•-•- Contraetor's Name___4_ _- _ 4 /. . - OaPJS e// ;�"p7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms --7--N-umber -of baths _1_____ Lot size _____ Water Supply: Public system �[� Community system ❑ Private E] Depth to Water Table 3.L ft. Character of soil to a depth of/3feet; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:— (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Tank• Distance from nearest well---�------ .--- Distance{ from ,foundation__________________ Material ------------------------- -_______________._____- ��'"� No. of compartments------ ------- -----------Size-----•• - t ------------------._ ^Liquid depth ----------------- --------- Capacity----------------------- Dispos lid Distance from nearest well ----------------- Distance It from'foundatian___ ~_______________Distance to nearest lot line ______________... Number of lines____________---�_--�- _-_Length•of each line ----------- of trench____________________..___- - - - - --------- Type of filter material ------------------------- Depth of filter material --------------- _------ Total length _______________________________________�_ Seepag P1t Distance to nearest well ---- !_-.__._Distance from foundation__ld__..____..Distance to nearest lot line ... Number of pits -------- )----------- Lining material____ .Sif y�e: Diameter.------ _-B--____ Depth .... S2�-._�---------- r _ Cesspool: Distance from nearest well_________________ Distance from foundation._.____ I `________.Lining material_____._______-_-_____________________. ❑ Size: Diameter ---- ------------------------------ Depth --- }------- -----------�--1 Liquid Capacity -- -------------------------gals. Privy: Distance from nearest ---------------._DiOance,from nearest building ---------- --------------------- ----------. ❑ Distance to nearest lot line ----------------------------- --------------- -C Remodeling and/or repairing (describe):___ -= ------- ----- - •-----• • -- ---------------------------------- -••---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat41a_� rules and` -r ulations of the San Joaquin Local Health District. (Signed) ��__.+'' -- ------ --- --- By: - Owner and/or Contractor Ry•------------------------------••-- -•-- --- -----(Title)--- {Plot plan, showing size of lot, location of system in rely i to wells, buildings, et an be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------_T'-- -•----------------------------_ ------------------- ----------------- DATE------�--�-�--- �v- - -- -- ----------------------- REVIEWEDBY ------------------------------------------- -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED ------------- ------------------------------------------------—-------------------------------------- DATE - Alterations and/or recommendations:________________________ ____ __ �.;�------------------- -- ------------------------------------- -`� Y- -----------------------------• 1� &3 nfi - -- 'r 9,. - --------------------- ----------------- -.. C ry�—c� FAQ ir' a t ---------------------- n ,w_eA ` .'-� � FINAL INSPECTION BY:... �1 �� ` l�-- �!iC {! c Date---- � 1 ' 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 Revised V59 F.P.CO.