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► APPLICATION FOR SANITATION PERMIT Permit No. ----- (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 application is made in compliance with County Ord-onance No. 549. JOB ADDRESS AND LOCATION----- -. `�4 ------�4-------A��ipeV-----'. ........ �l -•-------------------------- Owner's Name------------- ----------� �1/_ .E7� -----------------------,----------------------------------- Phone] =,s7Q 1V......4 11-1-,V",41-----x°77----........'_1.�----- Address--------------------`�'� ---------------....._.-----------------------------------•--•-------- Contractor's Name___- +. -=--- A 'f �5/ --- --S� ,S-__. �� ----•------------•----•------------------ Phone. :'�0_'_l� a: Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I----- plumber of bedrooms Number of baths Lot size -------- --___�_ --- ------------ Water Supply: Public system ❑ Community system ❑ Private Dk Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 5C New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ 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--------------------Material_____________________-__________.._.__________- ❑ No. of compartments--------------------------Size......-------------------------Liquid depth--------------------------Capacity...._--------- ------ s Disposal]Field; Distance from nearest well-f_/",1�-____Distance from foundation----/jV __.Distance to nearest lot line--Id------- Number ----Number of lines---------------I_-----------------Length of each line-------2_f________.(-------Width of trench--------?-V. "r •, Type of filter materiaL____�G�1C.____Depth of filter materiaL_____/Ar ----_Total length---------�+�________________________ Seepage Pit: Distance to nearest well mDaterancelffrro�mefoundationDiam ` t 1 -2 __ -_ � _____.Distance #o nearest lot line________--.. ® Number of pits- - g Diameter ._.Depth - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F-1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building------------- __________________._____._. �] Distance to nearest lot line---------------------------------- -------------------------------------------------�-----f-----------�--------------------- -------- �! Remodeling and/or repairing (describe)------ ----- �-•------------- ---------C 'L::/- ----•----------------------------- �l ---------------�- ------------------------------------------------------------------------------------------ .� r --------•------------- ---------------•----------------------------------------------- -------------------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 law sand rules and re u tions of the San Joaquin Local Health District. {Signed) -'-` �'------� ' '---------(Owner and/or Contractor) Title------- -•� - LZ.�--------- (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. DATE-c;,,::,—---------------------------------------------------- REVIEWEDBY--------------------------------- -------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------•---------------------------------------._ DATE-----a..-3►------------------------------------------------- Alterationsand/or recommendations:----------------------------------------------- -•--------------------•--•----------------------------•------------------------------------------------------- -•------------------------••------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------:-- ---------------- -------------- -------------------------- -------------------------=--------------------------•---------------------------------------------------------------- --------------------------------------- " "........ -l-6------we- '"---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.---------�Li+r . �•*---------------------- Date - � ' 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 ES-4-2M , Reviser 1.57 F-P.CO.