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5� APPLICATION FOR SANITATION PERMIT Permit No. __1?_C,Fo87........ (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 her in described. This application'n'iiss mad in compli ce h ourr / inance No. 549. � �+�� JO ADDRE55 A L ` -� G --�- ----- Owner's Name :--------- - --------------------------------------------- Phone 0� S. r . Address------------------------•- le.iW ----------------------- -------------------------•------------------------------- ---------------------------------•-------------------------------- Contractor s Name--- ------------------------ ---- ----- Phone------._...-•--------- - - ------- --------••-•--------- - -------------------------------------- ------------ Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other ❑ �? 4 ;".. . ¢ Number of living units:•_ _____:Number of bedrooms _ ___ Number of baths ______,Lot sizep- _ �•8 - �--•--------- Water Supply: Public system ❑ Community;systerri'❑'PrivateDepth -Water [ableft. e.� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adore❑ Hardpan ❑ Previous Application Made: Yes ❑ No. ,; New-Construction: Yes A No Q FHA/VA: Yes ❑ N ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. ''�"�� (No septic tank or'cesspool permitted if public sewer is avail a within 200 feet.) Septic Tank: Distance from nearest well___- ---_Distance from foundation___ �3_.______.Materiaf_ -_-- -_-- No. of co' artments:. -----------_ Size,- rlC_!� x-,Liquid ,depth_______ _ __._Ca acit p Y �-� Disposal Field: Distance from nearest wel!_- (J .:.Dista ; p nce from foundati n_ ------Distac to nearest lot line_____ _._. j [ Number of lines_______„_: Length of each.line______ -------- itith b trench --'________________ Type of filter material_ �1--.�-Depth of filter mate ria___ r�__'___._Total length_'___`f�:C _ --------__________ Seepage Pit: � � Distance to nearest well_.."=�__�__, � Distan`ca from foundation-------_.------------Distance to nearest lot line:___------------- Linin material______ -------- `_____-. Size: Diameter_.__-____ ___..-_- ' - Number of its Depth------------------------------- Cesspool: Distance from neare'st wel!- ....:....::. .Distance from foundation______''-- --------Lining material_----------------- ----------- ❑ Size: Diameter------"-"____----------- - -- Depth-------------- -------------------------------------Liquid Capacity-------------•-•-----------gals. +. - Privy: Distance from nearest'well-------_--------------------------------------------Distance from nearest building----------------------.-----------.___'_. ❑ Distance to nearest lot line-.----'"'=------ =------------------= = -' --•---- t Remodeling and/or repairing.'(describe):--- ----------------------------------------------------------------------------------•----- ---------------------------------------------------- y . ---------L----••---------------------------------'•-------------- ----------------------------------•'•-----J--------------------------------------------------------`-------------•---',--------------------------------- ` i' --------------•--------------------------------------•-------------------------------------------•--=-------------------------------------------------- -- ----------------------------------------------- I hereby'certify that I have prepared this application-and that the work will.be-done'in accordance with San Joaquin County ordinances, laws, and rules and reg Iations of the San Joaquin Local Health District: 1 (Signe - �� 1�� ; r. , ,o f (Owner and/or Contractor) - ---- ------ - - --------------------------------------------------- - -------------------------------------- = ---- {-- - } F {Plot plan, showing size of lot, Iocation of.s stem 1n relation to.wells, buildin s' etc.,-can(biele)__.._•____________________________.____-________._________.____ p 9 y g , placed on reverse side). . q " '+ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- _._. - ---------- DATE------- ------- - REVIEWED BY------------------------ '1 E` DATE f/ BUILDING PERMIT ISSUED----- = DATE = - = - Alterations and/or recommendations: ------------------- ------------------------------------------------• ---------. -----------•------------•---------------------- r -------------•------•------------------------=----•-••--- •--- --------------------------------•-----------------••------ -------------------------------------•------------------------------•------------ ------------------------------------------------------------------..____-_«_-,__-____--_.________________-_____________-___-_.____.____-.---___-_- } L INSPECTION BY: `__ _ - ----= ._.._.-- _ Date---./ ------------- 1. -' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streef 814•North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21x1 , Revisoo 1.57 F.P.CO.