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APPLICATION'.FOR -SANITATION PERMIT Permit No. ._-1.- f _ _„!,___[Complefe in Duplicate] T — Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe"✓ This application is made in compliance wit unty Ordina e No. 5 q- Z 3 —07D—C 2_ .. '7,7A. 1- Cs-,e ? r r JOB ADDRESS AND OCATION_; --- R.� ;rl Owner's -_-'_„_---- Name-------- �- -------------- ----- -------- ----------------- - ---- ---- ------ --- --------------------------- ------ Phone Address-----------c -- x w Contractor's Name________________ _ _______ --------------------------------- I ----- - ------ ------------ Installation will serve: Residence p ❑ A artment House ❑ Commercial Trailer,Co t � Number of living units: ----_--- Number of bedrooms -___-___ ❑ °tel ❑ Other ❑ Number of baths o size __-_ i Water Supply: Publics stem -- --- Y ❑ Communifi system -"""----------- Character of soil to a depth of 3 fee+: Sand ❑ Y Grav� PriSatd DePfh to Water Table/_& ft. Previous A lication Made: Yes No 4Construction: � Y Loam ❑ Clay.Loam ❑ Clay ❑ Adobe ardpan [] pp ❑ �ew, Construction: Yes ' No TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ FHA/VA: Yes ❑ No ❑ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ic- k: Distance from nearest well__ --------_ --- Distance from foundation-------------------.Material No. of compartments-- ------ ' --- ----Size--------------- ' Liquid depth Capacity-- ---------------- Dis osal Field. Distance from nearest well____-" -_ Distance ffrom fou#dation---cam Distance to nearest lot line- ------ _ j Number of lines--k_._ _"_ Type of filter material_-- ! -Length of each line_-- - - r._ sir --------.Width of french.--- [ _ /-f�� cDepth of filter material------, --------Total lengthX ----- Seepage Pit: Distance to nearest well_____ _________ ___Distance from foundation-__.-___ 1. ° � ❑ Number of pits----------- Linin g material____-_____.__- Distance tos I° ine_____ ) . fff/// * )- Size: Diameter----- -------------------- Cesspool: Distance from nearest well _________ _----Distanceff om forndation-------------------- \� Lining material-_'Size: Diameter----- -------------I---------- i- Depth-------------------f -------------------------------- -- . __--_Liquid Capacify Distance from n crest—will----' ;--gals. , --- ,--f-Distance from nearest building _Distance tonearest lot"line------ ------------------------ ------------------------- ------------------------------ Remodeling end/or repairing"(describe):_-.-_-- ----------- ------------------------------- ?:-------_---- - ----------- -------------------------------------------------------------------------------•-------•-------------------------------------- - - -------- -- ---- --------------------------------------------------------------- r I hereby ce ify that I h v repared +his application-and that the work will be done in accordance with San Joaquin County j ordinances, to a law -'and ule and regul tions of a San Joaquin Local Health District, (Signed).- --- -- -- -- --- - -- --------- -- --- -------- ----- - ----- ------------------------------------------- By:------------------------------------- Owner and/or Contract --- / or) I : (Title) (Plot plan, showing size of lot, Iota ion of system in relafi o ells, buildings, a+--- can be t placed on reverse side). FOR DEPARTMENT USE ONLY °P APPLICATION ACCEPTED BY`�_- - "-- ----------------- -------------------------------- REVIEWED BY DATE__ ,. ----------------------------------- ------------------------------- "-- DATE__- BUILDING PERMIT ISSUED_ s ----- -------------------------•----------- - ----------- DATE----Q° Alterations and/or recommendations:---- - ._ -- ------------------------------------ --------------------------------------•--------•----------------------- ------------------•------------ - - "---------------------------------------------------•----------------------- ------------------------------- ---------------------------- ---- - ---- -------- ----------------"------------- FINAL INSPECTION BY___ _ __---------- Date r r . ....-- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stocktonr California Lodi, California Manteca, California Tracy, California ES-9-2m , Revised 1-57 F.P.CO. I