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APPLICATION ,FOR SANITATION PERMIT Permit No. ."/G u (Complete in Duplicate) Date Issued -""(-Zf�S� 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 ------ ------------ wner's Name _G � S -----•-- --i--- ----- ---------- _ Address ---------------------------- .. Phone ---- ------------------------------------------------------------------- -------------- -- ""--•---------------•---------------- Contractor's Name----------------;-""""_"--" Phone. " Installation will serve: Residence ! [Apartment House ❑ Commercial Ll Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "-/--- Number of bedrooms -_ Number of baths _/--- Lot size --_y f D d ------------------------------ Water Supply: Public system a--community system ❑ Private ❑ Depth to Water Table yS ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 19 New Construction: Yes ❑ No [—FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) � 1 Septic ank: Distance from nearest 'well----------------- from foundation--------------'_- " • _ - Material No. of compartments-------------------- -----Size--------------------------------Liquid depth------------ Capacity Disposal i d. Distance from nearest~well.,..--__-------#Distance from foundation------------------_Distance to nearest lot line----------------- Number Number of lines"(-_ =Length of each line Width of firench----------------------------- T e of filter material-"" YP I f Depth of filter material— J1 ----------------------Total length---------------- Seepage Pit: :9 Distance of nearest well ll__-e .�nln Distance om foundation--_,/_D � - - _"-"" -_"-,Distance to nearest lot line---�"d---- Numbeg material--- Size: Diameter` '*------- Cesspool: Distance from nearest well---------------- Distance from foundation-------------------- material Size: Diameter_ r -".-__""__-._"--__-"_._ ------------- �-------------------- ------------Depth---------------------------------- --- ----------Li Liquid Ca acit Y --------------------------gals. Privy: Distance from nearest wel)--------------------------- " ---_--.-_____-""---Distance from nearest building ❑ Distance to nearest lot line__-"-_____"""____-".--__-__-".-._"""-_ i Remodeling and/or repairing (describe):_" "-.. - --- ------------------- r --------------•-------------------------------------------------------- �. -------------•-'------------- ------------ a - --------------------------^-----••-------•---'-------------------------------------_-- ---------------------- q I -----------------------------=------- ------•--- ---------------- - --- -------------I---------- =-----------------------------------------------------------------------------••--I-•----------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 44 (Signed)- 4- ----------------------- ----- -------- -------.(Owner and/or Contractor) - By:--------------- Ti+le "_. ( ----- (Plot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., ) -v-can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- X0!--- DATE _% --_ 5----------------------- REVIEWED BY--------- --------------------------- ---------- - --------------------------------------------------------------------- DATE------------------------------ BUILDING PERMIT ISSUED------------------------------- -----------" ---- ------------- --------------------------•------------- ---------- DATE---------------------------- Alterations and/or recommendations:_------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------ ----- FINAL INSPECTI ' _P Lq Date-------1--2-9---. .7 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 1.57 F.P,CO.