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APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ (Complete in Duplicate) Date Issued,_/�1/ .-5--- • 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. X5449. e ^� / � -� ----------- ------- JOB ADDRESS AND LOCATION___________-- - --- - "" .... L✓ ---------- ------ Phone----- --------- 7 Owner's Name-"----- ---- - - -•-•------- --------- ----- ------ ------- --------------- ------ A'------- ---- ---- --------------------------------------------------------------------------- -------... �j� __ Phone_,----/--7 _� Contractor's Name--------- --- - Y '.' -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: ___,__ Number of bedrooms __j___ Number of baths __/__ Lot size ___` - -�- ...1 �3- Water Supply: Public systemommun'ity system ❑ Private ❑ Depth to Water Table--ft. of soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Loam ❑ Clay El �ardpan ❑ Character p Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ f' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet., ,/,� Material- --------------------------------- - ---------------- --- �- Septic Ta k: Distance from nearest well-_� Distance from foundation__. .___ �- No. of compartments----')--,------ "Size��__��G___- -----Liquid depth----�-�------------CapacityjQ°t';- - !' yC 10 G f 1ee Disposal Field: Distance from nearest well-_--Distance from foundation___!-_ Distance to nearest let line____ n Number of lines-----�---- ---------- Length of each line___-. --------------Width of trench__- -- ------r s Type of filter material_ _ . '� _�}� De Iter matenaL___� -�-----.Total length--------- --- ------------/ --- Seepage Pit: Distance to neare t we ----- "____- istanc ro fo ndatian____ �..___._.Dista e to nearest lot line__.___-__ L� -Linin aterial - __. --__ ____Size: Diameter___/1--__-Depth �P- _ ................ (`,4 Number of pits--�--------------- 9 -� � "v Cesspool: Distance from nearest well________________. fan te fro undation-_.._____--__.____.Lining material___.____..------- gals ❑ _Liquid Capacity--------------------- --- Size: Diameter--------------------------------------Dept ---------- --------- ------------ -------- g Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line--------------------- ----------------- " ---------------------------- Remodeling and/or repairing {describe):---------------------- -••--------•------------------------------------------------------------------------- --------------------------•--------------------------------------- \ ------------------------------------------------------------------------- -------------- -------- ------------------------ ------------------------------------ ------------pp-----------•------------------•------------------------------------- _ c I hereby certify that I have prepared thi a licatja and that the work will be done in accordance with San Joaquin' Coun ordinances, ;f�laws, and rules and re sans of pidan Jo q En Loca/Heal h District. (Signed)--------- �-------x--- - - ---- -- - ---- -- ------- -----•------- -- - � � Contractor) By:._.. - -- --- ----- - - . - �-G i---------------------------------- (Plot plan, showing size of lot, location of system 1n relation o wells, buildic., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ DATE--------fie REVIEWEDBY------------------------------------------------------ ----- -------------------------------------------------------- DATE DATE------------- ------------------------------- BUILDING PERMIT ISSUED---------------------------- s--- — ---- ----------------- �. -- ------ Alterations.a /9r ecommendations:-------------- ------------------- - --------------- - ?� � _.� ------------•--------------••------ - ----------------------------------- -- -----•------------------- --------------- ----- ----------------------- ------------------------------- ---------------- --------------------•-------------------------------- ------------------------------- J FINAL INSPECTION BY:..--- ------------ ------------------------------- ---------- SAN --------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Meatece, California Tracy, California ES-"-9-2M , Revised 1.57 F.p.co-