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. � 1 APPLICATION FOR SANITATION PERMIT Perm No. `'--- (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 compliancer'Jwith County Ordinance No. 549. ¢ '7 -- JOBADDRESS A �I.00A -- --F-�_._ --------------------------------------------- '- ------. --------------------....--------•--- _ _ ------- hone---------------_--- ----- Owners Name--- r --------------------------------------------- r.-. - ---------------------, --------------•------------- Address--- ------- . --------=-------------• -------= -- ----- -. --------------•-- , ------ w€ t " i -- i --- -------- -------------- ---------- -------Contractor's Name___ # - ; Phone lMtallation will serve: i Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units_ I umber of bedrooms u_ __ Number of baths __l___ Lot size _____ -------- table � ------- ------------------------ r i . Water-Supply: 'Public system! Community system.❑-"Private.❑`"Depth'to`Water Table __.____ f}: Character of soil,to a depth of 3 feef:j Sand ❑ .. Gravel ElSandy Loam❑ Clay Loam El Clay El Adobe Hardpan [I i Previous Application Made: Yes E] No [ -New Construction: Yes [� /No ❑ FHA/VA: Yes ❑ I No"� HYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted.i "public s///e��wer is available within 20D fee�,l]I- ' Se tic ank: Distance•from nearest well___ _ istanc fro oun�d ion_/ ,j '-.Mater alfa__ _______ ________________ e Z7 *: e� p .. ,��..� ! (' ------ No. of co#partments- � size 1�.aJ.--•Liquid epth-- �--i-------Capacity... I ___- Distance#om fo _.Distance to nearest lot line--- Dispos Field: Distance from ricer st well undation_� -.__� 1 Number of lines---'..!--= --- -- - ----------t Length o£ each line-----_-----t_-0---- ---:Width of trench-----�+�/ -----r-----------.. ___.(De th of r aterial____.___/:F-_____-Total Ion th_________ --L�--( ----------------- f ---- 9 Type of filter materi t��- p --- ------- Seepage Pit. Distance to-nearest well ' __-,Distan6jgm�foundation _,.__ w.Distance to nearest lot line________--------- Seepage _ ______ ❑ Number of pits -- -------Lining material__ ' ' __.:Size -Diameter------------------------Depth---------------------------------- El ------- ------ ------ ` A Cesspool: Distance,fro"m nearest well____ - _Dis ance fro' foundation___________ ___Linin material____ _ .___.- ._____..____ ___ `{,\ g Size: Diameter.'=----x--------------------------------Depth__ - - ----„ ----- ---=Liquid Capacity --------------------------gals. ❑ T� X, Privy: Distance from nearest well._ _ _ - --------'---------- ------------------------- ------ Distance from nearest building_ __________ _____________________ r Distance to'nearest lot line = ------------ ❑ j . (describe): " - ------------------ - -----------------•-------------------•---------------------•--•----- - Remodeling and/or repairing _. _ = ------------------------------------------- • a '----------------------- r - --------------------•---.----•----------`---`------------------'--5-----------•--------------••-------"---'---'-----^--------,-------'-------------'-'------ -------- 1 hereby certify that d he this application and that the work will be done;in accordance with San Joaquin County ;ordinances, State laws, and rules and regulations of t - San Joaquin Local Health District. Contractor) ' ,, (Owner a on rac [Signed}- �� `� '. --- {Ow nd/or tor] i -- __Title--------------------- ------------------------------- ---------------•- -------- -------- -------- { } {Plot plan, showing size of lot, location of s stem in relation to'wells;'buildings; etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY - DATE`01 APPLICATION.ACCEPTED BY__ ---- ---------------- ------------------ -------------------•------------------------- --------------------------- iREVIEWEDBY------------ ---=- ----------------------------- DATE_-53----------------------------------------------- / -- a ;BUILDING PERMIT ISSUED_____...____ DATE_____ - --------------------------- ----- -----_.----------------- Alteratians and/or recommendations:_. 3 ----•--------- ----------•----•---------• ----•---------------- x If ----- -----I -------- -------•----------- ------ ---------------- ------- - , ------ •-.' ` ' Date--------- ��--��--��-��=-------- -------------• FINAL INSPECTION BY______ACN �` ' R SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street iStockton, California Lodi, California Manteca, California Tracy, California 'I ES-4-2M Revised 1.57 F.P.CO.