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k � ' ! APPLICATION FOR SANITATION PERMIT Permit No. (� �0 (Complete in Duplicate) Date Issued ----- Application --_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. 1 JOB ADDRESS AN C fION-______��-3- � -- Az�- u.M ___ Owner's Name-------- —' - -- -- ---- --_----__-_ Phone------------------------------------ �.._.__ Address - 'n'' ---------- - --------------------------------- Contractor's Name-------------- ---------------------------------------- Installation ------------ - -------------•--------------- -•-------------- t � --------- ----------------------------------- Phone f7 ��f d Installation will serve: Residence partment House [:], Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of livingunits: _ f ` Number of bedrooms`__Number of baths � Lot size _,,��__�---��-G9------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table'5S ft. Character of soil to a depth 6f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made:'11Yes❑ No R?'New'Consfructioni Yes 0 No''a-�_FHA/VA:-Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance,from nearestweft_______._____-__Distance from foundation___________________Material______________.._____________-__-_________.__. No. of compartments-- -------------------Size--------------------------------Liquid depth-------------------------Capacity.... 1%05Id: Distancejfrom nearest well_________________Distance from foundation________________-__.Distance to nearest lot Iine ______________ Number' lines Length of each lineLAJ-------------------------Width of trenchh I ; Type of filter material_:______________________Depth of filter material-------- ____________Total length_____.____-_____-__________ { --------------- 41 $ _97-;P og t: Distance'110 nearest well ___ _______Distance m f ndation__�Q___.___.Distance to nearest lot line__� __ Lining materia 3?3 ,-----_ De tn__ —� ® Number of pits---- Size: Diameter.__ Cesspool: Distancefrom nearest-well________________Distance from foundation__--_,____________.Lining material__.___--______.____________-_______- ❑ Size. Dia meter --------------------- Depth---------------I----------------------------------Liquid Capacity---------=-----------------gals. Privy: Distance)[from nearest well._____________________________________________._Distance from nearest building____.______________________________._ ❑ Distance�to nearest lot line_____________________________ ----- Remodeling "Remodeling and/or repairing (describe)----------------------- -----•------------------------•------- -------------------------------- ______________________________•___________-_.__-___________-___-______-_-.__________-__-._____-__-______________________-__-- ___i___ II -----------------------------------------------r---------1.-------------------------------------_____ i I hereb cert) that I heave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tae la s, anq rules and roe of tate San Joaquin Local Health District. � i (Signed) y 1 C?_ .! - ----� ---- - ------------- -------- -- --- ----� ------------------------ Owner and/or Contractor) BY: I --L T {Title) (Plot plan, showing size of lot, location of system in relation to w , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --- -- -- ------ j DATE REVIEWED BY DATE----- - d BUILDING PERMIT'l -r-------•--. - ---- ---------------- ------ ----- --------------------------------------- -DATE-------------- -------------------- Alterations nd/or rec mm dations--------- ----- ------------ ~r --------- ----------- --------------------------- a F --------•----------------------------- - ---------------------- ------------ -- - -- --- ---• ---- ----- - 'S_ -- �.(hi� � `t� — ---------------------------------------- -------- ----------- --------------------------------------------------------- ----------------------- ---------- -------------------- -------------------------- FINAL INSPECTION BY:_-�' .. ___ ._ / ✓ l ---^---l----- T -•--•------------- - Date-----�---�-=- �-------E�----��---- ---------------- ---------- I; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California I" Lodi, California Manteca, California i Tracy, California 1 i ES-9-2M . Revised 1.57 FJP.Co-