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APPLICATION FOR 'SANITATION PERMIT - Permit No_ 7- �__ ' (Complete in Duplicate) �� R _ - Date Issued ------------ _�__ Application is hereby made to the San`Joaquin Local Health District for a permit to construct and instal!the work herein de This application is made in.compliance with County Ordinance No. 549. Q© I ` o�D -� F scribe-U. JOB ADDRESS AND LOCATION r . _ ` Owner's ------. Name.--------- – – ---- ------------ Address - Phone _ ----- - -- - -------------------------- ---------------•-- --------------•---•=---------•-----•- Contractor's Name--. ,�,�� Installation will serve: Residence -- .......................... Phone-•---- ❑ Apartment House ❑ Commercial Number of living units: _ -.__ Number of bedrooms_ ❑ Trailer Court , Motel ❑ Other ❑ r T --- Number of baths _% _- Lot size ___ •__--_--- ` Water Supply:"Pubfrc system�❑ Community system ❑ Private® Depth to Water Table _'" __ Character of soil to a depth of 3 feet:`Sand �J Gravel ❑ Sandy Loam ❑ ClayLoam ft d Previous Application Made: Yes ❑ Clay ❑ Adobe❑ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:❑ � Construction: Yes M No ❑. FHA/VA:1A/V,4: Yes ❑ No ❑ (No septic tank or`cesspool permitted if public sewer is available within'200 feet.) Septic Tank: Distance from nearest well_}'-� _r'1M _7 is from foundation_ No. of compartments---- _ _____Size_- ------ -'Material:--__-.- :- Disposal ---•-------• ----Liquid depth-----47!---- Disposal Field: Distance.from neares}-well-Ai" a au y-._ -------------- Distance I from foundation--?tA+u-_--- Number of lines___.---_ '__ ---Distance to nearest lot IineQ_�_.____ � y Length of each line----�� -_- ---- Width of trench-.--a.4/'!- Type of flier material-- _" " -__Depth of filter material-- ---__--- To}al length-.-- _--- Seepage Pit; '' - *. ----- O r ❑ } Diitance topnearest well________________ __Distance"from foundation---'-,------'_______:Distance to nearest lot line_ k N i mber of its------------------------ ---- -- --- - ------Lining material__- - 0 Cesspool: - Distance f+,om nearest well-----------------Distance from foundatonDiamete4------------------+ a},Depth __._._____ ❑ 5ize::Diameter. .°-F - g. erial----------------- Y Distance from nearest'well---- Depth------------------- --:-Li uid Ca aci , Priv 9 '.. f p tY ' ------- gals. -_. �. . ----- ------------=-----------------_---_Distance from nearest building .Y Distance to nearest lot-line:: -��- -_ - - fi' Remodeling and/o r F '•� �+.-��w,._...,s- . , _ -------------------------- '- --- -- r repairing (describe):-_- ' f 7 ----------------- ----- ------------------ --------------- ---------------- _------ .}-------- - ----------------------------------------------------------------0---------------•------------•-------------------- I hereby certify that I have prepared chis application and that the work will be done`in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District, , (Signed) ----- ---- - L := -------- Owner and/or Contractor Plot Ian, showing size of lot location of system in relation to wel E ( ' -- ---- - ------- f - ( p (Title} - ------- --- - 9 ls,'buildings, etc., can be placed on reverse side). q FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY-- ------------------------ DATE `'�7--�-`{' REVIEWED BY . F - -------- . DATE BUILDING PERMIT ISSUEQ------------- ----------------- -- ------------------------------------------- ---=--=-------------- DA Alteration a for regom d ° _ ------- E , � - -- -•----__- •--•--- -_---- ---- ----- ---- --- --- '' •.. -------------------------------------- FINAL INSPECTION BY:'- Da te-C e .", " --- ------------••--- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, Celiforrtie ' 1 132 Sycamore Street 814 North "C" Street 1 Lodi, California Manteca, CaliforniaI Traey, California ES-9-2M Revised 1.57 F.P,Co. - 1