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APPLICATION FOR SANITATION PERMIT Permit No. ...____._. __911 i �(Complete in Duplicate) Date Issued -_-! - �- Applica#ion 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__.-_6,<_Zj/-----�----- Owner s Name---------- - --- --------- ------------- ---- Phone------------------------------------ Address------------- B-4.----• ------7 - - ------- -------- -.- - --------------------------- Contractor's ---- ----------- Contractor s Name------.---.�-4L.__-- • --4 `-�- - _n----------------------- Phone---411- s� Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms Number of baths J---- Lot size ------------- ---•-- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ______"ft: Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe . Hardpan ❑ FHA/VA: Yes ❑ No [ Previous Application Made: Yes ❑ No x New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) S ti Distance from nearest well________________Distance from foundation------------- --------Material------------------------------------------------- No. of compartments------ -------------------Size-----------------------------------Licl6id depth--------------------------Capacity----------------------- r is osa 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 material-------------- ---- ---Depth of filter material-----------------_---Total length-------------------------------------- q , s - 1�5 Distance fr m fou ation___.�f__0_=___-___.Distance to nearest lot line�__.�__._ ._. ge Pit: Distance to nearest well-_--- - -6�it-- - Number of pits-------,�-----------Lining material----- ___ - 06 .Size: Diameter__-• or/ Depth Cesspool: Distance from nearest well-----------------Distance from foundation------ _------------Lining material------------------------------- al-- s. ❑ Size: Diameter------------- ----------- ------Depth----------------------------------------- -------- Liquid Capacity g Privy: Distance from nearest well-_---_--------------------- -------------------Distance from nearest building------------------------------------------ ❑ tnea = stance o rest lot line_________________ ___ --------------------------------- Di Remodelin and/or repairing (describe):--------- --------- -------- -------- -------- -- - ---------- --- ------ -- -- - - - ------------- -: --- } ------- ---------------------------------------------------------------------------------11--------------------------- -------------------------------------------------------------------------------------------- I hereby certify th I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat e la nd ru and r u ions of the San Joaquin Local Health District. Si ned { ----- --- ----- (O n Contractor) - : .__ caner and/or { By:-------------------------------------- --- ---------------------------------- (Title} ---------- (Plot plan, showing size of lot, location of system in rela+ion t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY • -------------------- DATE------------- i/-`� f-- ---------------- DATE----------0----------------------- REVIEWEDBY-------------------•---------------- ----- DATE------ ------------------------- - --------------•------- BUILDING PERMIT ISSUED--------------------------f- -----`---- ----------- -------------- ---•--- ----- -------- - Alterations and/or recommendations:----------€----------- - -------------------- ----•------------ --••-----------------------•--•------•------------•-- ------ S" -----•-- iT fe TJf ------ '- -- /0- ---------------------------------------------- -------- --------------- --------- ---- -------- Date.- 1 ---------------------•----- 1 FINAL INSPECTION BY:__ __ ___. ^• ,• SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street $14 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M Revised 1-57 F.P.CO.