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—I APPLICATION FOR SANITATION PERMIT Permit No. _.14 ._.. (Complete in Duplicate) Date Issued .f.ls.7------ Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. f JOB ADDRESS A OCATION-. - � --/--�- - - -- - - r - � '..'..° .........l 3�..6 ...:.. Phone.Name........ �+ --- ------------------ - -. t X '"-�"Address----....4L ---- -----•--------- y4`. -- Contractor's Name � naPhone 4 �Q�� T " Installation will serve: Residence [[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other F-1 Number of living units: .... Number of bedrooms Number of baths I.... Lot size x ------------ Water Supply: Public system ElCommunity system Private_❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand Gravel 0 Sandy Loam ❑ Clay Loam 0''�y Q Adobe❑ Hardpan ❑ Previous Application,Made: Yes ❑ No New Construction: Yes 0-;No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j � � c Tan Distance from nearest well.I- .0 -Distance from foundation.....Lp--------Material-- _-_:__. C. No, of compartments �� p � -_. Size_ _ __t!I" �___:___Liquid"depth p.-..........Capacity ! . tante from nearest from foundation----/0.........Distance to nearest lot line... .................Length of each line_____-J`D____� /. - es___.�--__-- � __---Width of trench �� .... " _ ._--__Depth of filter material.....- -----------Total length.........V . __....... Seepage Pit: _____________Distance from foundation--------------------Distance to nearest lot line................. 0 Number o Lining material---_-----------------Size: Diameter...................___-.Depth_-____--_ _...._... _....._.. Cesspool: Distance from nearest well._•*..._'.,,__Distance from foundation--------------._....Liining material...................................... ❑ Size: Diameter-- ------------------------------Depth..-- ----•-•---•----.---- ._....Liquid Capacity . ...... .............gals.. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____ _________________________________ ❑ Distance to nearest lot line----- -------------• -----------------------------............................................................................. Remodeling and/or repairing (describe)------- ------ ----------- •------------------•-- ---- ........... ............................................ -------•---------------............................................. -----------------------------------•------------------------......-----•-- -------------•----------. rr--`` --------- ------•-------------------•--•-------------•----•--- ------------•--------•-----------------------------•.............................................................--- •--... ---•- • "V 1 hereby certify that I have prepared this application and that the work will be done inaccordancewith San Joaquin County .O ordinances, State laws, `and rules and regulations of the San Joaquin Local Health District. -(Signe --4---- -- I Contractor) BY:.............................................................................. (Title) (Plot plan, showing size of lot, location of system in r ion to wells, bui rags, etc., can be placed on reverse side),. FOR DEPARTMENT SE ONLY APPLICATIONACCEPTED BY-----------W -------------------------------------- -------............................... DATE------ ..: _d.... - .Lr......------- _--- ^ REVIEWEDBY----------------------------- -- ------------ --------------------------------------•---------•------- --------------- DATE...................................................... BUILDINGPERMIT ISSUED..............................................................-...................................... DATE.................................M..................... Alterations and/or recommendations ------------------------ ----------------------------------------•-- ------•------------•-----•--••-------------•--•---------•---------. ---------------------------• -------------------------------------------------------- - ----------•------- ----- -------- .................... ......- �4 FINAL INSPECTION BY:.. - Date - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ameripan 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.