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APPLICATION FOR SANITATION PERMIT Permit No. 4 pe (Complete in Duplicate) y r� 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. JOB ADDRESS AND L CATION-- ---- ---1-0-------- ---------------__4TC ►J------------------------------------------•------------ Owner's Name----------- 5 ` � ------------------------------------ -------------------------------------------- Phone------------•-------------------•--- - KAddress---------------- 3-77-d'0_---------- ---------Rf?j��------------ : ~ ----- -------------•--------- Contractor's Name-------------OW-K-r'-�•--------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence N( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living units: --- Number of bedrooms -_ Numb r of baths _-L---- Lot size -------------------------------- Water Supply: Public system ❑ Community system E] Private I Depth to Water Table 461- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p 9---,_-_ sfancl from foundation_--_-(©___---.M terial---- ------ - - -- ------------------ Se c Tank: Distance from nearest well--- - Di - No. of compartments---------_------f__--Size-- I ------------Liquid depth-_- T----------------Capacity---- i -------- Disp�sal Field: Distance from nearest well____-----Distance from found10— ation_S- 11--_-_---.Distance to nearest lot line---S_--------- Number of lines---------- 1 _--- Length of each line------so - ------------ of french r_ .`---.-_- Type of filter material_-1 & -Depth of filter material----.tit-------__---Total length----vtDQ--------------------------_. 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: ----------------- --Size: Diameter-------------------------- -----------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. � Privy: Distance from nearest well---------------------------------------------------Distance from nearest building----------------------------------_-----. ❑ Distance to nearest lot line-- --- ----------------------- ---------------------------------------i-----------_--------------------------------------------------------------- Remodeli a^n /or repairing (describe):--.- A�- � - __\ ___A_---] -__-llM.r ...............�__ A=te[--1------------------------------------------------------------------------------ -------------------------------------------------•-------•------------------------------ -----------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- - ---- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules a e ulations of the S n Joaquin Local Health District. (Signed)----)----- - ----------------- - - ------------------------------------------------------------------------ --------(Owner and/or Contractor) By--- - ------------------------------------------- --- -----------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, wing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ ----- --------- ------- ------------ ------------------------------- DATE----------- REVIEWED BY - ---------------- DATE "1 ------------------------------------ BUILDINGPERMIT ISSUED------------------------------ ---------------------------------------------------------- ----._ DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------------ ------- ---- ---------------------------------------•-•---------------------• ----------------------.------ *--- -- ---------t-----------------i- ----- - - ---------------0------------4-------------------A-------- --- - ------- ------------C------ ----- t-L ({ ----- -----------------------------------------------------------------•--I------------------------------------------------------11---------------------------------------------------------------------- --------------------- FINAL INSPECTION BY:. -�'"`�"`-- ----- Date j l �2 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 ES-9-2m , Revised 1.57 F.P,CO.