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APPLICATION FOR SANITATION PERMIT Permit No. �-r__ __ (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 application is made in compliance with County Ordinance No. 54.9. JOB ADDRESS A D LOCATIO Owner's Name__- - - ------------ ----- --- ------ Phone----•------ Address .3 .�' ----- ---- - - -- ----------••---•--1•------- Contractor's Name Phone Installation will serve: Residence [ Apartment Mouse El Commercial ElTrailej, Court ❑ otgl El Other ❑ Number of living units: _-�- Number of bedrooms � Number of baths -��Lot size __-_ / _- Water Supply; Public system E] 14 Community system E:] Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: Yes E]I Nox New Construction. Yes No E3 FHA/VA: Yes ElNo TYPE OF INSTALLATION AND SPECIFICATIONS: ;l (� (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I r.-4P No. of com art nearest well__ tDisfance from foundation-- _�- Materiaf_ Se is Tank: Distance from ments..-___ _-"------------Size �{�-��Liquid depth-_._--- � Ce acit `� s�� -J' P y----/` Disposal Field: Distance from nearest welt.- Distance from foundation___,;X' --_---Distance to nearest lot line - --___-- Number of lines' Length of each line- „r___ • ��-- �-�-.Width of french.- Type'y of filter material---t5�Y __Depth of filter mater ial------/_�-rf__-__Total length-----/-P- ------------------------ Seepage Pit: Distance to nearest well---------------------- from foundation-------------------.Distance to nearest lot line_----__.-__-_._ ❑ Number of pits--- ------------------Lining material-----------------------Size: Diameter-----------------------Depth----- -------------- ------------ Cesspool: Distance from nearest welt-----------------Distance from foundation-------------------"Lining materia!- -------------- ------- ------------- ❑ Size: Diameter Depth Liquid CapacitY---------------------------gals. Privy: Distance from nearest well---------- --------------------------------------- Di€stance from nearest building ❑ Distance to nearest lot Eine-------------------------------------------- Remodeling and/or repairing (describe)----------------- ---------------------- - ------ ----------------=----------•------ --------------------------- ------------------ ------------- ----------------------------------------------•-----------------------------------------------•----------------------------------- ----------------------------------------------- - ------------- I hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County + ordinances, State laws, and rules and regulatioMs of the San Joaquin Local Health District. I (Signed)----- l S - y ----&._ ------------- ---------------------------------------------------------------(Owner and/or Contractor] By: --------Y --------------------------------- -------- -- ---- ----- ----------(Title)------------------------------------------------------------ , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCE=PTED BY------- ------------------------- •----------------- DATE REVIEWED BY------ ------------------ -------- --=-- -�------------ � DATE----- ---- ------ 9L.." v -------------- --------------BUILDING PERMIT ISSUED---•----------- -------------------- - ---------- DATE------- -------`------------------- " ----------------- terations and/or recommendations:"------"_-.----- _ ------------------------------------------------------------------------------ ------------------------------------------ ----------------------•-------- ---------------- ---------------------------------------------------- ------- ----- ------------------------------------------ ------ --- ---------- FINAL INSPECTION BY:.-- ----- _ Date -: = ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street r r r 300 West Oak Street 132 Sycamores}rem±^ 814 North "C" Street Stockton, CaliforniaLodi, California Manteca !Cya1'ifc '6 Tracy, California ES-7-2M , Revised 1-57 F.P.CO. I '� a"