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R .._jo-S 3.7.• APPLICATION FOR SANITATION PERMITS Permit No. (Complete in Duplicate) U •�� Date Issued Application is hereby made to the San Joaquin Local Health District fora permit toconstruct and install.the work herein described. I This application is made in compliance'with County Ord' ante No. 549 r' JOB ADDRESS AND"LGCATL�01N_ = �1 cOwner's Name--------4 -- - �� Ql Phone Address------------------s -----------------------------:----- Contractor's Name-------- -------=----- -------------•-----------------------•----------------- ----- Phone----------------------------------- ----------- will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: /___ Number of bedrooms _X-- Number of baths . t___ Lot size _/ ------------------------------------ Water Supply: Public system ❑ Community system E] Private �6e�pth to Water Tablevr,0 ft-' Character of soil to a depth of 3 feet' Sand ❑. Gravel ❑ Sandy Loam�ay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ - No g�r New Construction: Yes.p?-1'4o ❑ FHA/VA: Yes W?- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welll-p-�� -------Distance from foudnndation___�Q________.Mater �_ No, of compartments-------94--------------Size_x,/�j��{��fz__-___Liquid depth__�4.__-___-_ Capacity...l�Q i10, 4 Disposal Fi - Distance from nearest well__10.-----Distance from foundation__-`___:__..Distance to nearest lot p g a�� W) " is Number of lines___(___ _ ____________ Len th of each line J _ss. of trench-___ •�j+�_______._____________ Type of filter materia l---/ / Depth of filter material- length length______,, Qp---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to'nearest lot line________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-_-______-____--____-__---------_____. ❑ Size: Diameter----- ------------------------ -------Depth------- --------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well -- --------------------- ---------------------Distance from nearest building------------------------------ ------ ❑ Distance to nearest lot line-----------------------------.--------------- I 1 Remodeling /or repairing (describe]_______________ __ �� L - Mi ---------------------------------------- ------------------------------------------------.-------•-------------------._--------- r 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, an rules and reuI tions of the San Joaquin Local Health District. (Signed) / � ------------------------- �r Contractor) ..I _ --------- ------ (Title)-------- ------------------------------ (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be-placed on reverse sid4. _, 42 FO EPARTMENT USE ONLY J. - APPLICATION ACCEPTED BY-- + , •---------------•-------------------- DATE-------/------ - rT----------------------- REVIEWED BY- --- -------------------------------- ----------------------------------------------------------------------------- -------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE__----------------------------------•--•-----------------_ Alterationsand/or recommendations--------=---=------------ ------------- -------:-------------------------------------------------------••--------------•-------------------•--------------=---- I ---------------------------------------•------------------------------------ - --•------------------ ------------------------------------------------------------------------------------ - ----------------------------------------------------------•-••-•-----------_----------•----------------•-----•------------------------- Vi ------------------------------------------------------------------------------------------------------------ ---- 10, 6�ti Date -----FINAL INSPECTION -------- - "SAN vq " JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street p Stockton, California Lodi, California Manteca, California Tracy, California ES-=4-2M . Revised 1.57 F.P,CO-