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APPLICATION FOR SANITATION PERMIT Permit No. ... rr��.... (Complete in Duplicate) / Date Issued __9l_��1 S Application is hereby made to the San'Joaquin Local Health District for e permit to construct and install the work herein described. This application is made in compliance,w' h County Ordinance No. 549Ulvd --17 i9 2_ JOB ADDRESS AND LO A ION t � ---------------•-------i--- ---------------------•-----•- Owner's Name L ----f-•• - -- -- ------------------------ Pho,e------------------------••----•-•--- ------------------------------------- ------------------------ Address � - -------------- ---------------------------------•-------------------------•------•------- Contractor's Name------._ ---------------- ------------•------------------------------------------------------------------------------•-------------- ---- Phone---------------•----- ------------ Installation will serve: !Residence Apartment House E] Commercial [—] Trailer Court ❑ Motel ElOther E]Number of living,units: ---I---- Number of bedrooms ---_��__,,__�� ff 4-2f��Number of baths ____f__ Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table t. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 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.) Sept' Tank: Distance from nearest well----j?(1---Distan fro fundati y /_ _ MaierP _ No. of compartments-.---`2-�---------Size---Ot ----------,9-----------Cap acity --- --- ----- Disposal Field: Distance from nearest wefi__?Q-------Distance from founclation___,/_01► -.Distance to nearest lot line____�r_'.______._ Number of lines_______________________ _ Length of each line-------- ___--- --Width of trench.- -. ��l____-_----- Type of filter material__ - ;-Depth of filter material__.____-� __te_Total length.:_.___ _Q_-__-________________ p Seepage Pit: Distance to nearest well---- fro f un ion __.�_r�—.__..Dist ce to nearest lot ine____ -_d__ N Number of pits------ ------- ----Lining mataria�r _ _ iameter------ --------.Depth------- --: --- ------ ---- Cesspool: Distance from nearest well-----------------Distance from undation-------------------lining material___.______.,,____________-___________. ❑ Size: Diameter-------------------- - --------------Depth----------------------------------------------------Li Liquid Capacity----------------- - � q p Y --•------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.__-".--______ ❑ Distance to nearest lot line- -------------------------------------------------•------- Remodeling and/or repairing `(describe)--------------------- ------------------- ---- __--- ,. / f ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------ -------------------------------------------------- 1 hereby certify that I have {prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rul s and regulations,.of.the San J aquin Local Health District. {5i ned F--- --- ----__Owner an 9 ) �` C �� dor Contractor By:-------------------------------------------------------------------------------------------- ---------------------------- -------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------ -- == ------ DATE------ REVIEWEDBY-------------------------------- --------------------------- DATE---------- BUILDING PERMIT ISSUED-------------------------------------- - ------ ---- - - ---------------------------- DATE --•-- ------------• Alterations and/or recommendations: --- ---------------------------------------- ----------------------------------------------------------------------•----------------------•------...------------------- ---------------------------------------------------------------------------•---- -----------------•----------------------------------------------•-------------••----------------------------------------------- -----------------------• -------------I----------------------------------- ---•---------------- ----------------------------------------- f -----------••-- FINAL INSPECTION ------ -------------------------------- = 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-9-2M - Revisaa 1.57 F-?.CO.