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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued � I-y��_-- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work described. This application is made in compliance with County Ordinance No. . JOB ADDRESS AND'L ATION_L ` �c�ir = "�`7.C.►®�.J�( E :. ----------- ------------------------------------------- Owner's Name- - '� r .! Cc` �fC�t ---------------_----V_ • --------------- Phone Add res s---_-•----------------- Contractor's Name--- -----------------•-•------•-----•-----•----=-------- - - Phone # -••----=----------------- Installation will serve: . Residence-d' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ ,Other ❑ Number of living units: ------- Number of bedrooms - - Number of baths__/--_. Lot size ____- tf --_'y-/--_ -----•--.--._ 5 Wafer Supply: 'Public system ❑ Communify system ❑ "Private 'Depth to Water Table -_ --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ r Previous Application Made: Yes ❑ No - New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFIC TIONS: (No septic tank.or'cesspool ' ermifted if public sewer is available within 200 feet.) Se _T nk. Distance from nearest well-----------------Distance from foundation--------------------Material-_- _----..__---_.-----__. No. of compartments--------------------------Size---------------- ---------------Liquid de th--------------------------Ca acit Dis oral f=ield: Distance from nearest,well ]__�L;..Distance from foundation--_Z_61____-.--Distance to nearest lot line-_•__1S7_. Number of lines_-- -v Length of each line------__-- --- ---f--- - ---.Width of trench---!� Type of flter,material__ --Depth of flfer _-_Total length------ --------------------- L. ------------- ---- _----------------------- Seepage Pit: Distance to nearest well______________________Distance from foundation____.___.__..__-_-.Distance to nearest lot line-_.------_____-_ ❑ Number-of pits--4-------------------Lining material-----------------------Size: Diameter.----------------------.Depth-------------- --- + I = ------- Cesspool: Distance from nearest well-__----_-__:. ,Distance from foundation------------- -----Lining material---.__---____.----- _________. r _ ❑ Size: Diameter ------------------------------ Depth------------------=--------------------------------Liquid Capacity- ------------------ gals. W Privy: Distance from nearest well----------------------- N --------------------Distance from nearest building_` if -_------------------------------------ ------------- ------------- ❑ Distance to nearest"lot"line - - --=---------_----------=----------------------------- ------------ Rem'delin�g and/or repairing (describe):-- t�-��y ----s� - ..�--- t --- --= --- --- -----•- --- 1P----------•--------•----------------------- ----- ---------------- - ---------------------- ------------------------ a --ar ----------------------------------------------------•------------------••------------------ --- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County,- - ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . (Signed)--------- n. -------------------------_----------------•-----------------•-=------------------' Owner and/or Contractor..)_ t E1-'C - tJ`----- ••------- ------------------------(Tif le)---------- -•---- ----- ---_ -- � Pot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)--- 'i, t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_--___._f--_--_ - ------- -f_ _ _ ( ---- --------------------•----------------------- DATE_:------ } REVIEWED BY. =------- � - . DATE--- . -- --,- -- -y----- --f� -- - - ----------- ------------------ -----:- �----- BUILDINGPERMIT ISSUED--------------- ----------- --------------------------------------------------------------------- DATE--- --------- Alterations and/or�an /or rec�geZndLa�t1ionss:}------- -„--_-�--�r---.-------��------'-�- '' A- 7 -- --- ------ ---------- 2----------- ----- � � ------ --•-- �-�'_.� --� f / --. ------------- ------------ ---- ----------------------------------- :..- ----- ---------•-------------•----------•-- -- ----------------- --------------- - ------------•------------------------------ ------------------ FINAL INSPECTION-BY:.----_-_)o' ------------------- �. .� Date- ;` SAN JOAQUIN LOCAL HEALTH DISTRICT '" In 130 South American Street 300 West „Oak Street 132 Sycamore Street 814 North C„ Street Stockton, California Lodi, California Manteca, California Tracy, California t ES-9-2M Revised 1.57 VP.CQ-