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APPLICATION FOR SANITATION PERMIT Permit No. .-__..1.!_s8a___ (Complete in Duplicate) Date Issued --_- oes=- 2-W-0-0 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-Ord-inafice No. 549. JOB ADDRESS AND LOCATION- Owner's OCATION Owner's Name - - - -•------ -- ------------- - - ----- .. Phone-------------- Address----- - �.�� Contractor's Name------------ - • -r-£�i/--/' ---- ---- -- - ------------------- ------------------------------------- Phon �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Traile Court [] Motel ❑ Other ❑ Number of living units: __ Number of bedrooms _ Number of baths -� Lot size -----/�_T_Q___ -__ _��p____r________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -/,/At. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe .Hardpan E❑ 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.) Distant ------Mat __Sep Tank: Distance from nearesi _/0-- No. ____ , fiif /--------------- O of compartments_.___�1,,,,_-�__-_____-Size__ __ _.Liquid d j th______ _-_..___Capacity__��_C7`___ Disposal Field: Distance from nearest weil__40-4/XDistance from foundation__ZO__________Distance to nearest lot �� _ ❑` Number of lines__--___�----------------------Length of each line_20_7.7Q-.4O_.Width of trench____ _ ..-___________ Type of filter material_ x�a_C '___Depth of filter material___f :"'___--__Total length------/J�_J_______________________ � n k�v .�� Seepage Pit: Distance to nearest wef!__ Vie. ----Distance f foundation__ Distance to nearest lot line___b_'>__________ - --.. Number of pits__ _.._.____Lining materia!___ - ize: Diameter--.-- —':Z:?- ----�`�. `.. - -----.Depth---�..� � ----------- Cesspool: Distance from nearest weft-----------------Distance from foundation--------------.-----Lining 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):------------------------------------------------------------------------------------------------------------- , ------------------------------------------•--------------------------------------------------------------------------- ------ ----------------------------------------•-•---------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereb_y.ce21aws 1 have prepared this a 'on and that the work will 6e done in accordance with San Joaquin County ordinances, Statd rules regulat' s e San Joaquin Local Health District. (Signed)------------- - --- ---- . ... ---- ---- ----------�� (Owner and/or Contractor) By--------------------------------------------------------------------------------------- ------ (Plot plan, showing size of lot, location of system in relation to wels, buildings c., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------------------------------------------------------- DATE------ � ' REVIEWEDBY--------------------------------------------------------------------------------- -------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------- Alterationsand/or recommendations:-------- ----- --- ---------------------------------------------------------------------------------------------••----------•---------------------------------- -----------------••-------------------- -----------•- - ---------- --------------------------------- ��` ---------- - -------------------------- --------------------------------------------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECT BY -- ----- ---- - -- I� Date-------------- -- ". s 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 I ES-9-2M Revised-11.57 F.P.CO.