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APPLICATION FOR SANITATION PERMIT Permit No. _.__-1 (Complete in Duplicate) ` Y 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 549. �y JOB ADDRESS AND LOCATION---------- � -----Z- --— Owner's Name--- tk -------� X- ............... Phone-A01 -_ C� Address--------- -----------------------------•----------------- w - Contra - _•--� �tor's Name- .--�--- - � L- ------el '-- ------------------------------------------ Phon�.�_��-Q. _------- t Installation will serve: Residence Apartment House ❑ Commercial s❑ Trailer Court ❑ Motel ❑ Other F] d Number of living units: _- Number of bedrooms __�/ Number of baths _>1" Lot size ----_ �_�C_(_z-- �_......................... 1 Water Supply: Public system Com mun`sty1system ❑ Private ❑ Depth to Water Table,_ ft. Character of soil to a depth of 3 feet: Sand Gravel'[] Sandy Loam ❑ Clay L atn ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE•-OF INSTALLATION AND SPECIFICATIONS: 49:1- No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic.. Distance from nearest well-----------------Distance from foundation------------_-------Material-----------.___._____---._--__--_-_---------._--. No. of compartments------ - --Size--------------------------------Liquid depth---------------------------capacity----•------------------ asal Distance from nearest well-_ " _.Distance from foundation•__/°_____.Distance to nearest lot Number of lines--__- __- Length of each line______ ° Width of trench.-----.- �' ii - 9 W. 14- A � Type of filter-material_ _ -----Depth of filter material----./ .......Total length------------------------�.______._. Seepa e Pit: Distance to nearest well___. f�CiQ___ pistanc from foundation____!'___..___.___.Distance to nearest lot line___4____..__" r Number of pits___________________Lining material��i�S�____Size: Diameter__�3_t_{--___.Depth__._.,e�._�___ ____________ Cesspool: Distance.from.nearest ----------Distance from.foundation.- ------------Lining material---------------- ------------------ Size: Diameter.------ ---__ i.7:A_ � Liquid Ca p q p Y .De th------------------ ----_--------------------------Li acit gals. ❑ t4n Privy:+ Distance from nearest well-------- "�'_- from nearest building 1 �1 /l- -------- 9--- ----------------------------------- Distance to nearest lot Dine---- - -----______---------------------------- 13 --_ ______________ ______ ________ � r ' Remodeling and repairing (descri4j :-____-_ _ - j. - ----------fi---•---------•--------- ---- -- ' -L - - --7 r ' ------------•-------- ----------------- -------------------- t------------------------------------------------------ � 4 6- __ , -here6y certify that I have prepared this application and that +he work will be done in accordance with San Joaquin Count ordinances, State laws, and rules nd regulations of`the'San.Joaquin'Local,Health District. ned �~ (5i g )Dk- `� '' ------ Q ------ ------------------------------------(Owe-andy/er--Eontractor) t By:-----------------------------......•------•------------- -------------------------------- -----�`---------- - (Tifle)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to ells, buildings tc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY •. r►, y ° i' j APPLICATION ACCEPTED BY------------- --------- ---- -------------- ------------------------------------------- DATE------------- -----. = ' REVIEWED BY = - DATE-------------I ----- BUILDING PERMIT ISSUED------------------------------ - - ----- ----------------------------------------------------------- DATE------------- Alterations and/or recommendations------ - --- ----- ------------ -- -----------------------------------------------1-- •------------------------- ------ ------------- -r ----------------------- ------------------------------------ --------- -- --------------------------------- -- ---- -- -- - --- -- --- ------- --------- -----`_---- - --------------------------- ,if C --------------------------- ---------------------------------------------- i � FINAL INSPECTION BY:..- -------- � Date--------- ------ - ---- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 1.57 F-P.Co-