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E AFPLICA ION FOR SANITATION'RMIT Permit No. __/ta /.JC../ l (Complete in Duplicate) ? Date Issued 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. S49. JOB ADDRESSAND OCAjTiQN � .r ,F'1r l J'A - Owner's Name--- - ---------------------------iHclt / �tf"- / `�l - ---------------------------------- --------- Phone-- �----------- --------------------- Address..------:..._ may/ �- Contractor's Name--------- i ' 1G%"---------------------- =- Phone... t j Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other Rg g umber of baths _ Lot size _/'1_1., f' ------------------------ Number of living units- _:- Number of bedrooms ___..... N Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. I Character of soil to a de th—of 3 feet: Sand Gravel Sand Loam t ` P _ ❑ ❑ y ® fay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E],.No P!r�New Construction- Yes ❑ No.R- FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool.permitted if public sewer is available within 200 feet.) Septic Tank: _ Distance from nearest well_----_._____..Distance from foundation4_._...............Material__.---..°_:_..--._._.:.-.-.........- :...-._. -- .. No. of compartments - --------------Size Liquid depth ':, au} f ,/ P Y- -------- --------- Dis os I Meld: Distance from'nearest wellZ ` ' ��(� � ` _ ..,�__Distance from foundation:.-_....__----Distance to nearest to I' e.-.e,J�� ` ti f Number of lines------ ..____ _ Length of each line.... °_---;� -_- Width of trench____..... �/ a T: �. TLLType or filter material _ - �f'_ -Depth...of_filter material:_.. - .Total rlength_-..-. Q.-�---- ..._= Seepage Pit: Distance to nearest well----------------------Distance from foundation'_____.------------Distance to nearest lot line-------._°..__-- ❑ Number-of Rits-----------------,- : Lining material----------------------.Size: Diameter----------------- -----Depth------------------------- • fs Cesspool: Distance from nearest well------------- .Distance from foundation_-....I---.-------Lining material----------------..------_ ❑ Size: Diameter -------------DepthF------------------------------- ----- --------Liquid Capacity ------ ---- gals. Privy: Distancefrom nearest well-..._--------._ Distance from nearest 1'uildin ) y ------------------------ - Distance to nearest lot line............................... i Remodeling and/or repairing,(describe):--------- ---------------� t i ------- ---------------------------------- - ----- -------=----- V. ----------------------- ------------------------------------------------------ ----- `� 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. 3 (Signed)-------- , � r- - ti -�, --- --(CQaadt/or Contractor) By--------------------------- ----------------------------- - ---� --------------------- ---- � f��------------- -- -- }----ate` -- --- -- - -------- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------` ------ ------ --- ------------------------------------------- DATE---------- r REVIEWED BY -:--- ---- ----- - ---- ---- -- ----- . DATE-- BUILDING PERMIT ISSUED----------------- -_....--- - - ---- - -- DATE. ------------------------ ---------------------------- ---- Alterations and/or recommendations ------------ ------------------------- ---------- ----- ----- ---------- ------- -- '� '--------- -- - --------I------------------------•- --------------------------------------------------------------------------------------- FINAL INSPECTION BY:..' ----= Date I!] — ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street s , t 132 Sycamore,Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California ES-9-2 Mf . Revisea 1.57 F_P.CO.