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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 Ordin ce No. 549. JOS ADDRESS AND OCATION. ' ----------- Owner's Name............ -------- - ---- --- `- Phone �/ - - ------------ Phone `-16kv -----------------------------------------------------•---------------- ------------.---------------------==------:- --------------------------------- Contractor's Name---------•-------- -- -� - l/L1-- ,y��R �, - � ----------- ----- a ---------------------�--------- - - - -----------�---==�---------. Phone - __ Installation will serve: Residence Apartment House ❑-"Commercial ❑ _Trailer4Court -❑" 'M'otel ❑ Other ❑ Number of living units: --/-- Number of bedrooms ___/%Number of baths --- Lot size �� _,k_� r -------_----------------------- pe Water Supply: Public system �Commuriity system El Private E] Depth to Water Table. _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gr`vel ❑ Sandy Loam E] Clay Loam [I Clay E] Adobe Hardpan ❑ Previous Application Made: Yes E] No UR- New Construction:: Yes Rr-_N_6 0 FHA/VA: Yes ❑ No Z- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) eptic T nk: Distance from nearest well----__--_-r______Distance from foundatibn__'_______________-Material_________________________________.________. No. of compartments Li uid.de th- ° "size--------------------------- - - - - Capacity P G p ti a p tY isp sal field: Distance from nearest well Distance from foundation._-,«"�`/-___Dis'tance to nearest lot �� Number of lines-------------------------- __Length of each line_-_____A_ �ri___�Widthsof french.---AXfr------------------ Type of filter material/j/1 �'Depth of filter material--_/f?�-_______Total length-------- __________________ Seepage it: Distance #o nearest well.__-__"' "----------Distance from foundation----/ _Distance to nearest lot line-----------T1___ Number of pits-----/--------------Lining material_Afd --Size: Diameter__.,7��-------.Depth------ Q------------------ Q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------_------ {� ❑ Size: Diameter---------------------------------f--Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. \� Privy: Distance from nearest well----_____-----------------------------------------Distance from nearest building__-_-__________________________________._. ❑ Distance to nearest lot line------------------------------- -- ----------- -------------------------------------------- Remo 3Fng an e r n (des ibe):.____ --__ _ -------- --------------- -- -------� 1 - = -----------------------=---------- -------------------------- I hereby certify that I have prep------------- ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r •ulations of the San Joaquin Local Health District. (Signed)------------- -------(G4n%Rz;ffRPj*r Contractor) Title------- By:----------------------------------------------------------- -- ---- -- - - ---- -� - -----------------{ ) ��--�---.----- -------------------- (Plot plan, showing size of lot, location of em in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------7Tf--R tO_- - --------------------------------------------------------------- DATE--------I -y-' 5 *5--9--------------------- REVIEWEDBY-------------=--------------------------------------------------------- ----------------------------------------------- ---- DATE--------------------•--I------------------------------------ BUILDINGPERMIT ISSUED-_--_---------------------- ------------------------- --------------------------------------------- DATE---------------------------------------------- -------------- Alterations and/or re��m dat n � f -=-------I--`_R .Q "------------- DateS� r----- FINAL INSPECT! - �- - - --�- - - --�- ---- -- ----------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street• f 300 West Oak Street 132 Sycamore Street �_1� ` 814 North "C" Street Stockton, Califgrnia Lodi, California h`Manteca California , `' °�Tracy, California ES-9-2M Revised 1.57 F.?.CO_