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,yly'i nom/ APPLICATION FOR SANITATION PERMIT Permit No. /0---- (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. 549. - e JOB ADDRESS AND LOCATION----------?4! ` ..... ------- ------•-------.�� '----------------------------------------------- Owner's Name--------- a)&A/----- 1 - e Phone Address------------------------""2 j _- ` ----------- -----_-_- '-----------------------------------------•------------•--••------------ Contractor's Name_________________ _ __ t 1 � ` a •� " --------------- Phone , I�i-� Installation will serve: ResidenceApartment House E] Commercial [:] Trailer Court ElMotel [-] Other E]_-- Number of living units: _--- umber of bedrooms Z__ Number of baths -1---- Lot size ____.___ 1" _ s -l7..______________ Wafer Supply: Public system X Commuriify system ❑ Private ❑ Depth to Water Table __�o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No� 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic'TTrrk:- Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------_ ....... No, of compartments--------------------------Size------------------------------ Liquid de th_________---- -Capacity Dis bs ie„ : Distance from nearest w II._.�bAjF Disfance from foundation_,--.____.Distance to nearest lot line___' ��p Number of lines-----------------------------------Length of each lin e------- -l- .-.Width of trench--•---- 1140�� Y, of filter material------{� -_Depth of filter material-----f�--------Total length-----,50____-__________.-.__-. Seepage Pit: Distance to nearest well---- Distance from foundation._ Distance _ _ ,�a�_____..Distancp to nearest lot line__,_-_______ Number of pits___._I____________Lining material____ . e- -.Size: Diameter__.__... . _____..Dept h-----�-�---�______________ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------------------------- _._.___ N ❑ Size: Diameter--- ----------------------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well _______________---------------------------------Distance from nearest building---------------.____________________- -.. ❑ Distance to nearest lot Iine--------------- -------------------------------------------------------------- -------- ----------------------------- ----- ----- -------------------------- i-Remodeling and/.or repairing fdescribe):_,,_,�_�_ _ -------- ----- ----- - -•----------•- P --- - ------ _ -- -------- --- ------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------••--------------------------------------------- ------------------------------ I hereby certify 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 r ufations of th Joaquin Local Health District. (Signed)------------------------- ---------- a ---- (Owner and/or Contractor( e By-------------------------------------------------------------- ------4�_ -- ------------- (Title)(Plot plan,plan, showing size of lot, location of system in relation to well , uildings, a+c., can be placed an reverse side). FOR DEPARTMENT USE ONLY '[� APPLICATION ACCEPTED BY---------- . - - - ------ -------------------------------------------------- DATE-•---- " ( ----•------------------- REVIEWEDBY-------------------------------- ------------------------------------------------------ --- ---------------------------------- DATE----------------------------------------- ----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------- ----------- Alterationsand/or recommendations------------------------ ------------•------------------••-------------------------------------------------••------------•--------•-------------------------- -------------------------------------------------------------------•------- -------------------------------•-- ---- -- -- "" - ----------------- - ----------•----------------- FINAL INSPECTION BY:------ _. -- - .---- --- Date------- ---- ---� ------ --------- SAN JOAQUIN LOCALEALTH 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 Pevisea 1-57 F.P.CO.