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V� i 4 ``!! APPLICATION FOR SANITATION PERMIT Permit No. 7 - (Complete in Duplicate r' Date Issued ____��Y 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 LOCATION___'�e_7,_1„S,.1 Wit? Gd!r ', � '- jC�� Owner's Name---------- - ------- Address Z* --------- Q:--------+ - r----------- �r-- J Contractor's Name------------------ ------ t �. �`�� if-c�Dh�-------------------- ---------------- Phone-,7��_____-s� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __! _ Number of bedrooms _..Z.-Number of baths ___ Lot size ______40 _!_X__f• ---- Water Supply: Public system �xl Community system [❑ Private [❑ Depth to Water'Table 17-49ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No PHA/VA: Yes ❑ No.! TYPE OF INSTALLATION AND SPECIFICATIONS: (No sdptic tank or'cesspool permitted if public sewer is available within 200 feet,) , I : / Distance from nearest well_________________Distance from founda#ion--------------------Material--------------- ._____.- ------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--------------------- - p field: Distance from nearest well_________________Distance from foundation____- ------------- Distance to nearest lot line_______-----_____ Number of lines---------�'—'---------------------Length of each line------------------------------Width of trench Type of filter materia_I---------------------- -Depth of filter material-----------------------Total length------------------_------------------- if — it: Distance to nearest well -. O&!� ---Distance from foUpdation---� ........Distance to nearest lot Number of pits------_`____ _____Lining material' _____�C-1 ____Size: Diameter-__ ------------------ C -------_ _ C ool: Distance from nearest well_________________Distance from fdunda#iari3_------------------Lining material__-____-_______-____._ ❑ Size: Diameter------ --------- ------------------Depth_-- -----------------------I-------------------Liquid Capacity gals. f. Privy: Distance from nearest well------------------:___`'__------_______-_ -_Distance from nearest building___-__________________ ❑ Distance to nearest;lo# line-------------- ; -' ------------------------------ Remodeling and'/orrepairing (describe) ---------------- a_ _----•--- ,rte/ ------- - ------------------ ------------------------------------- ----•- - - - -- -----------------------------------------------•-------------------------------- ------------------------------------------------------------------•--------------------= __:Z-------------------=„------------------------------------------------------------------------------------------------ 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 rules d regulations of an Joaquin Local Health District. (Signed)_____________ fT�w�er ni ® r 1� and/or Contractor) By_----------------------------------------- �-CSG---------- =----------------------(Title------ � ---------- - (Plot plan, showing size of lot, location o system in.relation to wells, ildings, etc., can be placed on reverse side). C t 9 FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---------- =------------- ----- --------- DATE - ---------------------------------------------- REVIEWEDBY------------------------------------------------------------ ----- --- -------------------------------------- DATE----------------- r BUILDINGPERMIT ISSUED---------------------------------------- ---- -- ---- ---- --------=----------------------------- DATE---------- -- - ------------ - Alterations and/or recommendations:--------------------- ----- ------- - ----------------------------------------------------------------- ----------------------- ---------------- ----- -: :::: --- ------------- ----------- ---------------- _ D ------ ------ - - ---- ---- = - - r H FINAL INSPECTION BY:.._ _____ - Date ---- - ------- ------ SAN JOAQUIN LOC 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.