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�v�73`7a Q APPLICATION FOR SANITATION PERMIT Permit No. .J__-O_._`f- __/• (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 applicatiori is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCATION_` �y i ----� ----------------- Owner's Name-___---. -- - -- - - -=---- - - Address ----------- Phone------------------- - Contractor's Name----------------- - I -- Phone ------------------------ Installation will will serve: Residence EZI.;-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�. Number of bedrooms �.- Number f baths,(—/_ Lot size -a. .-. Water Supply: Public system ❑ Community system I Y y ❑ Private Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: Yes E] }No [�New Construction: Yes R-'No F1 FHA/VA: Yes Flo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -� �Distance from foundation_ f , � ,.. .. ��-------.Material--- No. of rampartmems------ ..-------- ---Size__�- _-x__-t40-_--Liquid depth---_!�/1 Capacity__-- '-.�r I-R,...' / o� P Y1090--- -- Disposal Field: In af"n`ce from nearest well ""�"-Distance-from* foundation_-;�_&'ir-__.Distance to nearest lot line- Q _-- �� '" NCOUum'berolines , -,.- - --.---Cengt�h of.�each-lines/•�f. _ ----Width of french....oy_��------------------ Type j of filter materiaL_� __&e;eDepth of filter material _ --Total length-_----1_e2Q-------------_---__-__�~ ~ f r See a ,Pit:. Distance to nearest well �----.7 _Distance from foundation--_ �. U p 9 _.Distanee to nearest lot line--- -___. ___ p --------- Linin material_/0_1 A&6eSize: Dim r G� ) ' Number of its _+ Depth- � A Cesspool: Distance from nearest well---__--__-.-_. - 1 _ Distance from foundation_____________-!"-.Lining material------------------------------------- V1 Size: Diameter Depth ----------------- -- Liquid Capacity---------------------------gals. Privy: D}stance from nearest well W Distance from riearest.buildin, -------------------------------------- Remodeling to nearest lot line__-_____ �`"" ` g ------------------------------------ - - ---------------- Remodelin and/or repairing (describe)-------------- - --- ------ -- g ----- -- --------- -------------- =-------- ------------------ ---------------------------------------------------------------------- - ------------------- ---------------------------------------------------------------- ------------------•------------------------------------------------- -------------------------------- --- --------------------;---------------------------------------------------------------------- ------- -- --- - ------------------------------ 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 and regulations of the San Joaquin Local Health District. (Signed) ------- --- ----------- ------- (�or Contractor) BY= I ------------- Title -- --------------------- --- (Plot plan, showing size of lot, location 'o system in relati_o� n �Js,��uildings, efc`, canYbe,placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__------_ -_ tk*VLc --------------------------------------------------------------- ? DATE REVIEWED BY--------- --------------------------- ---------- -- -- -------- �-------- ---------- ------------- ----- ----- DATE----- --------------•-------- ------------------------------- UILDING PERMIT ISSUED---------------------------•-------------- ----------------------------- ------- ------ ------------------------------------------ DATE------------------------------------------------------------- Altera+ions and/or recommendations:___-- . -____..____-_--__-__-_ _ ----------------------------------•---------- �? ''" H---------- -------------- ------------------- -•------------------ ---------------------- ----------------------------------------------------------------------------------------------------------------------------- /f FINAL INSPECTION :. µ Date------- - - � SAN JOAQU.IN'LOCAL HEALTH"DISTRICT E30 South American Street 300 West Oak Street 132 Sy amore Street � 814 North "C" Street Stockton, California Lodi, California, Manteca, California Tracy, California ES-9-2M,. Revised 1-57 F.P.CO. {