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aowl p I APPLICATION FOR SANITATION PERMIT Permit No. ___V9........ (Complete in Duplicate) Date issued --��-_5-�-- Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiod is made in compliance with County Ord' once o. 549. JOB ADDRESS 'AND LOCATION___ / - -- .--• ------------------------------------- -------------------------------••-Phone- --------- -------------------- _____--�-__�------- ---- - -- -- - Owner's Name---------_ // � -- ---- -------------- -------- r 1.9 _. .......-- !!--------------- -• - :- ---------- -- ---- --- ----------- --------------- �----------•------:--------------------------------------- Address 1 � ---- I Contractor's Name--- ------ - -- - - - ------- -- -aC.�----- - - - ------ ---• • Phone------------------------•-•------•- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C❑ Other ❑ Number of living units: __l___ Number of bedrooms __l---- Number of baths ---4-- Lot size ____________________.__. . �r A Water Supply: Public systemCommunity system ElPrivate ❑ Depth to Wafer Table -A'_'ft. Character of soil to a depth of 3 feet:. Sand j❑ 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.) g,�epji Distance from nearest well-----------------Distance from foundation------------_-------Material---------------.__________-______________.__---- No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------_Capacity----------------------- ! ispos ,Pial Distance-from nearest well..................Distance from foundation__-______________--Distance to-.nearest kat line_____--_-________ - -- a Number of lines-----------------------------------Length of each line------------------------------Width oftrench.------------- ----- --=------ - . of filter .material--___----________________Depth of filter material---------- ------Total length___._________________`- -______._____ le ,. .a 4 Seepage it: Distance to nearest well_ I �_-Distanceo fo ation�_____________.Dis ante to nearest to line__ ______.._ / - ��Size: Diameter,_.:f;7 j ,- 1 � NurribeF of pits-------! -----------Lining materiae - -- - � ��-------Depth-----�'C�-------------------- Cesspool: Distance from-nearest well-----------------Distance from foundation--------_-----------Lining material------------------------------------- . ❑ Size: Diameter---------------- -- - -----------Depth-------------:------------------------------------- Liquid Capacity gals. Priv Distance from nearest-well------------------------ ______________________---Distance from nearest building---------------------------------- --------------------------------------- { ❑ Distance to nearest lot line ---------- ---- -- = Remodeling and/or repairing (describe-------------- --- ----------------------- ------------------------------------------ i ih -------•---------------------------------••--•----------------------•-------- t: c -------------•----...-----------•-------------------- -------------------------------------------- ---------•--------------------------------------•---- ---—------------------------------- - 1 •- ' -----------------------------------------------------------•••------------------------------------- -------------------------------- -------------------•-------•------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r les and regulations of the San Joaquin Local-Health District. ; (SignSi ned _ ------ ed)---- By: /L/ -- --- ------- Contractor) ( 9 ) - ... ' �j gy---------------------------------------------- -- ------ -- - -- ----------------------=---------------- -----(Title)--------- - - - -- (Plot plan, showing size of lot, Iota of system in relation to wells, buildings, etc., can be placed on reverse sideK FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•------------- -----• ------ ------ -------------------------------------------------- DATE----- AZL- -------------------------------------------- REVIEWED BY- ----------------------------------------------------------- -------- ---------------------------- DATE- BUILDING PERMIT ISSUED-------------------------------------- ----- - --- DATE_..--••--` ..._ �� Alterations and/or recommendations------------------------- -- --------=------------------------ •----�-------- --------- -11 ` -----------------r --- -------- - ------ -----r 4 ,._. r' --- -•-------------------••---•-------- ¢� - ` . ----------------------------------------------- ------------------ ` ----------------------0_` ----------------- FINAL INSPECTION BY ,'. ------------------------------------ Date--- - 1 ---_1-.------------------------------------- SAN"JOAQUIN'LOCACHEALTH DISTRICT 130 Soufk American Street l 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. 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