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APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) / s Date Issued 7_ 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 Rrdinance No. 549.` N JOB ADDRESS AND L CATION.... -- .- ---- p` Owner's Name-------- ----- --------------- ----`----�----- - -------------- - -- ---- - --------- ---- -- ----- Phone --- Address-----------=------------------- --- ----------`-------------------------------- ------------------------------------- -------... Contractor's Name - � s`ti` Phone__C O.. Installation will serve: Residence. Apartment House Commercial'❑ Trailer Court ❑ -Motel ❑ Other ❑ Number ofsliving units: -------:•Number of.beclrooms __ Ndmber of baths __------ Lot size ____ __ _________ 4 Water Supply: Public systerri�ommunity system ❑ Private ❑`Depth to Water Table;_ ,F�,ftr.. ° Character of soil to a depth.of 3 feet::' Sand ❑ Gravel ❑ Sandy Loam ❑ ClaFLo�am p Clay ❑ Adobe ❑'Harrdpan ❑ Previous Application Made:-Yes ❑ .No' 0 New Construction: Yes 0, No ❑ FHA/VA:,,Yes ❑ r 'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Se;Oe Tank: Distance from,nearest well_________________Distance from foundation___ ___`_---------Material------------------------------------- No. of compartments----------------------------Size--------------------r•--------Liquid.depth----------------_----- -Capacity---=-•-----••---------- D�' -tsal FFieW: Distance from nearest well--Aw40 Distance from foundafiorn---J_F�---Distance to nearest lot line_____........ Number of lines_______________________ _______Length of each_line____,€ __Q_�___..F Width of french-----R, —ir._________.__ Type of filer materials----- __:_,Depth of filter material____' __*__Total length:__________' _----------- ______ S ag • Distance to nearest well '�L-O-k U___Distance f om 'foundation____ ..et`:.::_.bistanc to nearest lot line____________ Number of pits-.I----------------- Lining material---r�_. . _.1_ ------Size: Diameter--�'.:�---------.Depth-_- -�-----------_------- Cesspool: Distance from nearest well-------- ---Distance.from .oundation____-____�_-___-.Lining material_____________________________________- J ❑ Size: Diameter------------------------------------Depth-- t = Liquid Capacity gals. \� Privy: Distance from nearest well--------------------------------------------- ___Distance from'nearest building. -_nt_____________,-__________,_-- ❑ Distance to nearest lot line_ _ _---. r - :__- - -------------------- Remodeling - �1 --- - ------- --- -- - - ----- - ----------- Remodeling and/or repairing (describe]---- -------------------- ------=--------------= " -=------------•--------•• ... ---=-------- l ------------------------------------------- -----------------------------.w ------------- •----------------•-----------------• ------••---------•---•-----------------------------------...----•------------- ---------------- --------------------------------------------------------------•-----------------------------.--------------------- ------- -----------------•------------------------------------------------------------------------------ 11' ---------------------------------------------- I'hereb certify-that l have prepared this applic tion and•fhat the work will be done-in accordance with San Joaquin County ordinances, a laws, and rule' nd regu ations o the San Joaqui oval Health District. (Signed)..... ---------(flarCr Contractor Y. ---- ------ -------(Titles -•rte- ------------------- (Plot plan, showing size of lot, .location of system in relation t ells, buildings, tc., can be aced on reverse side). -FOR DEPA16MENT USE ONLY APPLICATION ACCEPTED BY-Q- --- -----------=-------' ---------------- ------ DATE X' --- ------------------------------------------ REVIEWED -- ----------------------------------- REVIEWED BY -----=-------=-------- . . = = DATE-------- ----- ATE f ------------------------------------------------ BUILDINGPERMIT ISSUED ---------`--------------j---------------------=-------------------------------- --------- DATE----' ----------------=------------=------------------ Alterations and/or recommendations: -= :; •----------------------------�-------------.- ......-=------------------ f �j / �G�`/ f ��t - X),_, 'fh�)- ��....#? h 40 ',x,------!_./........rr� ------------------------------- --------------��-----------=----------------------- ----- -.1�----------= ---1 ------------- ----------------------- ----------------------------------------------- -------- ------------------------------------------------ ---- ------- - - --- ------------------------ _ C FINAL INSPECTION BY: = ..f_ - ff -- .. __�� .•_ -� DatefC3 , =' ��_ USAN JOAQUIN LOCAL HEALTH DISTRICT 130 SouA American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 1.57 F.P.CO.