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APPLICATION FOR SANITATION PERMIT - Permit No. ____ S ...-- (Complete in Duplicate) �/ ! Date Issued /15 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 ---- ---------------------------------------------------- ----- ----- ------------- ------ , ,r , ---- ------ ------ --- ------ Php --------------------- Owner's Name--- __g1 > _ Address-......I --- ---f-- - -• ------ -- -----------------------------------------------•-----------------------------'----•- - Contractor's Name_____{__ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other ❑ g ,� _z1.X/alt Number of iivin units: ____ __ Number of bedrooms _� Number of ba+hs _�-Lot�size __ ----,_-_ . Water Supply: 'Public system Community system ❑' Private ❑ Depth to Water Table 'y ft. �F'. � •rr, i f Character of soll to a depth of:3 feet: Sand ❑ Gravel ❑:.,. Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:. Yes K-- No ❑ FHA/VA: Yes❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or'cesspool permitted ifpublic sewer is available within 200 feet.) w. �.� ( I. - Distance'from--foundation: Septic Tank: Distance from nearest well _____.- !_} --------Materr I_ -�--�__-______ f 1p s Size. �a -/ Co Liquid depth- - _1---------_Capacity---- Disposal -- No. of com artments-____ ___ ` Dis osal Fi Id; Distance from nearest well_:'Distance from foundation___a-�_�-------Distance to nearest lot line_____--S___�. Number Olin; ---- --- -Length of eachJline_�--y?4-�-------------Width of french........ -4/------------------- ------ of filter mate`ri6IC1 ? ____Depth of filter material._____ -�.� _____Total I length--------- _ __ �/ i Seepage Distance to nearest ell s ---- Distan om f ndation_',-/- -':__.__.Di•stanc� to nearest lot iine___S-_-___ Number of pits____�_ Lining material O"Cr?�-'_.Size: Diameter=_- _-_-------Depth___ � - - JE. Cesspool: Distance from nea4iesf;well_______________ Distance from foundation_. _:__________- Lining material__-__--__________________-_-____-_ Size: Diameter---------- --- ---------- = Depth-------- ----=--`-----------=-------------- -------Liquid Capacity---------------------------gals. Privy: Distance from nearest we]-------------'----------------------------1I__-_Distance from nearest building--------------.______________------_--___. 1. = Distance to`nearest lot line________------------------------:-__ - Remodeling and/or repairing (describe :'-----'------------_--------------------------•-_--- " "►. f 4 , ------------------- ------------------------------------------- •-' =------•--------: )s� #_ , ------------- ------------------------ ---------�'---'--;-= --•--`------------------------------------------- ------- -----------------------------.------ -------'=- -- ----------- --------- ------------------------------- ----------------------------------------------- I hereby certify that I have prepared this0 pplication-and.that the work will•be done:in-accordance with San Joaquin County ordinances, S 4 favus, and rule and r`egulatians''of t eSan Joaquin Local Health District. (Signed)---------- ' --- - ------------- ner and/or Contractor) By:--------------- - - - -------------------•--------------- --------------------(Title)-------- 4 --r------•-------•------------------------- - tl (Plot plan, showing size of lot, location of sys+e in relation to wells, buildings, etc., can be placed on reverse side). FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- _ ; - ---------'------------------ DATE--- � .1" S J REVIEWED BY------- = :. = _. ----------------- DATE - BUILDING PERMIT ISSUED------•---------------------------------------------------------------------------------------------- DATE - Alterations nd/or.recommendations:---------- --- --------------------------------------------------------------------------------------- _== !_ - ____________________ _________________ A __ I - ------ - - -- ------------- ---------------------------------- ------- ------- ---- ------------------------- --- ----- -------------------------------------------------------------------- -- FINAL INSPECTION BY:. -------- Date------ ------ ------ --------- -------- 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.