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APPLICATION FOR SANITATION PERMIT Permit •No.# l _ L.--.--- 2 (Complete in Duplicate) Date Issued I Application is hereby made to the San Joaquin Local•Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 549. e ------------------------ -------------------------------- I JOB ADDRESS AND LO TION �� -------- �5 --- Owner's Name � ��'� - fj Phone Address_------------- - -��G�"r--� --------------------------- / Phone __ ._l��ll -- Contractor's Name----------------- --- �J%� � ------------------------------------------- ' Installation will serve: Residence Rpartment House ❑ Commercial ❑ Trailer ,Court ❑ Motel ❑ . Other ❑ Number of living units: _/--- Number of bedrooms _f Number of baths _I___ Lot size --- v� ------------------- Water Supply: Public system ❑ Community system ❑ Private 94-'—epth to Water Table 4.�_'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within,200 feet.) ,pp��, __� 3 Septic T k: Distance from nearest well__� -_Distance ffrom foundation--R�0- ___..Mafie�al_ _1f '�'` __---- I No. of compartments_._._...- ----------Size__ } -��---------Liquid depth----- ,1,��---------Capacity-----IBX ----- Disposal ield: Distance from nearest well__- _ Distance from foundation____ Distance to nearest lot line___- [ Number of lines--------/------------------- ---Length of each line------- �- ___.___....Width of french----- _ --�____�----_----- Type hof filter material_ � _G '___Depfh of filter material-__.__1�---___._Total length__________________ ---_______-___ i Seepage -it: Distance to nearest well-/A57-----------Distan, om f/o�undation-3 ____.Distar<ce to nearest lot ..,. Number of its.__._ __ Linin materia�lC �i -----Size: Diameter----- Depth_-__r2� "_�_______________ p g ` Cesspool: Distance from nearest well-----------------Distance from foundation__------------------Lining material-------------------------------------- 0 ___________- -----________________-❑ Size: Diameter----------------- --------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.___-_-----___._______________- ❑ Distance to nearest lot line----- ---------------------------- ------------°----------------------------------------------------------------------------- ------------ Remodelingand/or repairing (describe}------------------------------------------------------------------------------------------------------------------------------------------------------- --- -----------------�------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby_certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ,,�I ordinano6s Stafe laws, and rules and regulations of the San Joaquin Local Health District. (SiSs ned '__ _ --- (Owner and/or Contractor) gned) - --------------- ----------- ; By:--------------------------------• ----- ------------------- ----------------(rifle)--- ----------------------------------------------- (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- --------------- DATE REVIEWEDBY---------------------------------------------------- -----------------------------------------------------------------------• DATE------------•---------------------------------------------- 1 BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------I------------------------------ Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------••--•-----------------------------•- ------ - ------------------------- --------------------------- ---------------------------------------------- --------------•--------------------•-----------------------•------------------ i ------------------- ------------------------------------•------- ------- -------'-=•--------------------------------------------- ------------- -- ---------------------•------------- } ------------------- FINAL INSPECTION BY:.- --- ---- -- Date .. _'_ +9_ _'lPr SAN JOAQUIN LOCAL HEALTH DISTRICT v 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-2M Revised 1-57 F-'P.Co- L