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r � ✓ APPLICATION FOR SANITATION PERMIT Permit No. -- --d-- gvyw (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta4l the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_---__---,"_C-)-------:-- +/ �- ------ Phone------------------------------------ Owner's Name----•--- �-_��--�,�'!]r!.------------ /J ��-- ---------- --- --•----- ---------------------- - -W Address.----------------- ----�------------'----��------------------------ --- - � � l - ¢ Phone7 14- Contractor's Name_____________ __ -- Installation will serve: Residence Apartment House ❑gg Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ Number of living units: _- _- Number of bedrooms _- Number of baths ---/-- Lot size ------:Z - -- --- ----'------------ Water Supply: Public system Community system El Private [3 Depth to Water Table __$'/Oft. soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam [:] Clay ❑ Adobe Hardpan ❑ Character of p Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [y FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: /l (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Sepfic Distance from nearest well_---------------Distance from foundation-------------------.MaferiaL____.__.__-_____.______-_-.__-------.---_- -. No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity---------------------- " D�19 os !d' Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----__------_.._- G�� Number of lines--------------------------------- Length of each line-----------------------------Width of french----------------------------------- °� Type of filter material------------ - - ------Depth of filter material-----------------------Total length___-_--._----__--___-------___----__---- Seepa a Pif: Distance to nearest well-.A/6-A)f-_Distance rom foundation__,;7;49---------Distance nearest lot line-_-f� Linin material--- l ,-.Size: Diameter---_ !umber of pits- �----------- g N Cesspool: Distance from nearest well-----------------Distance from foundation.- ___- .Lining material---------------------------_--___-_. ❑ Size: Diameter-------------------- -----.Depth----------------------------------------------------Liquid Capacity----------------------------gals. r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----_---___----------------------------- ❑ Distance to nearest lot line-- -------------------- ---- ----------j--------- --------------------------- 1111 . Remodeling and/or repairing (describe):___ ------ ----------------- ---------- --- ----- `' "`� ------------------- --------- --------- -- -- - - -- ----- --- - - ---=--- -----=---------==-------------------------------------------------------------------------- ---- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and u s and regu n of the San Joaquin Local Health District. 1 � // (Signed) --r��_.---_--.-- (Owner and/or Contractor) ._4__ !l __-- B ' ------(Title)------ ----------- Y•- -- -------•-------------------- ---- - (Plot plan, showing size of lot, location of system in relatA�=Ils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------4 "-------- --------- DATE----- `' /=��--------------------------------- -------------------------- - -------------------------------------- - REVIEWED BY--------------------- ------------ ------- ---- ------------ ------------ -------------------------------- ---------- DATE------------------------------- - BUILDING PERMIT ISSUED---------------------------------- --------------------- DATE-------------------------------- --------------------------------------- Al+erations andLor recommendations--------- ---------k------------------ ----------- -----------------------------------__.. --------------------------------------- 7 -. 1-F--------Dr-rtM---------��=--------1 P► C4i�l_N_ ------- --------------------------- -----•----------------------------------------------- --------------R a- ---------------------------------------------------------------------------------------------------------------- FINAL INSPEZM, N BY: - - - ---- __7Date------- � ._ 7---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revises 1-57 F.P.CO.