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APPLICATION FOR SANITATION PERMIT Permit No. ---�------------------ O b (Complete in Duplicate) Date Issued 0 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 compiiance with County Ordinance No. 549. JOB ADDRESS AND LOCATLpN __- _ 4 ' a��3 j` � ` Owner's Name-['�Wile----- �� U --------------- --------------------------�-- Phone__ �,�`43.U.�--- Address {� - - ------------------- --------------- ~' Contractor's Name--------- _--_-------- --------------------------------- -------•---- Phone Installation will serve:'' Residence Apartment House ❑ Commercial [] Trailer Court Number of living units: _/-__ Number of bedrooms I ❑ MO I ❑ Other ❑ � ___ Number of baths _-""_-_ Lot size E U Water Supply: Publics stem �►' --� 10------------------ y ❑ Community system ❑ Private ® Depth to Water Table'_r ff. Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam!❑ Clay ❑ Adobe Previous Application Made; Yes Hardpan ❑ ❑ No New Construction: Yes [r4No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (U o (No septic tank or'cesspool permitted if public sgwer is available within 200 feet.) C4 Septic nk: - Distance from nearest wel' / ,-i - ,. ,, ----Distance fr m foun ation---l--��- M t ri I No. of compartments_._'7_Size -•-= `- - _ t ---"--Liquid depth--_-- 167 -----------------Capacity- Dispos ield:�. _ Distance from,nearest well-:L 5�j_ Distance from foundat" ��l I �. Number of lines_ Distance to nearest lot li __ Length 6f--each-line--- "" -------------- Seepage Type of filter material-" :-"-`--- . - Zf------- idth of trench-- - -- Dep#h of filter material-_- n ❑' ----- ---------Total length_." Imp p ge Pit: Distance to nearest well_--------------------Distance from foundation_"_ Number of pit's_-"------------------Lining material------------ Distance to nearest e lot -- _ �, -----------Size: Diameter------------------------Depth------------------------ Cesspool: Distance from-nearest well-----------------Distance from foundation_ _Lining ma#erial___-"_-"-_-""-_-"___ "- o ❑ Size: Diameter.M+---""_-___ Depth ------•-Liquid Capacity------- gals U Privy: ' ,Disfan.ce`from nea.'rest Well -------------------- _"_____ -""__Distance from nearest building---_-.._" ❑ "Distanc�to nearest lot line_ -".__ ------------------------------------ } ----------- o' emodeling and/or,repairing (describe):_" U ---.--- ------------------------•------------ ,r ----------------- -------------------------------- - -- -A= --------------------•---------------------•------------•=----------------------------------------------------------•-----------------------------------"------------ ----------------------------------------------------- :I•hereby certify that I have prepared this'application and that the work will be done in accordance with San Joaquin County 0 ordinances, State laws, and rules and regulations f•the San Joaquin Local Health District. �4CdN CC�7 (Signed} - -�- ! I -- -- - d g [Owner and/or Contractor) . ------------------------------------------ y:.. ---•-------------------•------------------------------------------------ ' Title _ (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc., can be placed on reverse side). 64 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--_µ-.-_-"" _ r �~ t REVIEWEDBY.- -- ----- ------------------------- ---------------------------------------- DATE----------------- ---------------------- D ---------------- -- l BUILDING PERMIT ISSUED-""-- --. DATE------------- --� - - -- ---------- ------------------------------------------------------------- D U Alterations nd/Qr recommen ions:- TE__"-" ----------------------------- ------ - -------.---------- - A _ / - - '--f----- . -- ------- �P--�-�" �Q�--.-�'�C"{-�_ �-.�� --------- - --- ---- ------ -------- -- •-- - 'a¢Q•------•------- •--------------------- r J ------------------ j ------------------------------------ 3 -------------------------------------------- FINAL INSPECTION B --------V --__- � --------- Date --- ------ �------------- ------------ i 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, CaliforniaI Tracy, California ES-9—.2M Revised 1-57 F.P.CO.