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APPLICATION FOR SANITATION PERMIT Permit No. ------------------ (Complete _ -_-z_ -_(Complete in Duplicate) /A ` 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. JOB ADDRESS AND Owner's Name--- -------C'•-------- --- --- --- ----------------•------------------------ -------•-------------------------•----- Phone------------------------------------ Address 1�0t#/ ---- - -- -------------••-------------------•----------------------------------------•--------------------------------------- Contractor's Name---- ----------------------------------------------------------------------------------------------------------------------- Phone----•------------------------------ Installation will serve: Residence A] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -1----- Number of bedrooms- Number of baths 1---- Lot size !----'y Water Supply: Public system ❑ Community system ❑ Private.[ Depth to Water Table h7_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe K] Hardpan ❑ Previous Application Made: Yes 0--No X- New Construction: Yes &I -No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ Sep}`c }a _or' spl sewer is available within 2io0n0-,-f-ee#.)Pwl- pd$I Septic TankDistance from nearest el __JA DistaIce from foundata�te...ri_a ------_�-- , ------------- 91 No. of compartments---.------------ Size- -tf+_-r-------: -Liquid depth------Y-j--------------Cap Disposal Field: Distance from ne est well-I--------Distance from foundation_/*------------Distance to nearest lot line_--------- . Number of lines- -----_- Length of each line----k0!-----------------Width of trench--� �------------T-------- Depth -----_ Type of filter material- _ _-------Depth of filter material-_� "--_---__--Total leng# - Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------.Distance to nearest lot line----------------- El Number of pits---------------------Lining material-----------------------Size: Diameter-------------------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---°----------------Lining material----------------------------_--------. ❑ Size: Diameter-------------- -----------------------Depth------------------------ -------------s----------Liquid Capacity-----------------------------ga)s. Privy: Distance from nearest well--------------------------------------------- -Distance from nearest building----------------------------------------- El Distance to nearest lot line------------------------------------ --------------------------------------------------------- Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------- ----------- --------------------------------------------------------------------------------=------------------------------------------------------------- -------------------------------------------------------------------- ---------------------------------------------------•-----•-----------------------------------------------------------------_----•----•-----••---------=-----------------------------•------------------------------------ ---------------------- ---------------- I i I hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to I ws, and rules and regulation a San Jo uin Local Health District. Si ned - i - - ----- ---- -�-'�'-------- - ------------------------------------------(Owner and/or Contrector, -— B -----------�:? ---------•----_----------•-__._ = e (Plot P , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY ---------------------- --------------------------------------- i REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------- DATE ----•-------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE ---------------- Alterations and/or recommendations------------------- - ---------------------- i --------------------------------------------------------------------------- ----------------------------------------------------------------------------------------••-------------------------------------- --------------------------------------------------------•-•----------------------------------------•------------------- -----------------•--------•-•----------•---------------------------------- ------------•----------------------•-------------------•----------------------------- -------------------------------------------------------------------------------------------------------------------------- -- t -----------------------------------------------------------------•--•---------------------------------------------------------------------------•------------------------------------------- FINAL INSPECTION 8 SAN JOAQUIN LOCAL HEALTH DISTRICT ti 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 Reviseci 1-57 F.P.CO. r.