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I sm 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 Ordinance No. 549. JOB ADDRESS AND L CATION----- � ------------------ Owner's Name -r-------------- Phone- --------- ------ Address------- A..-- Q--------6�-" --- 1 C -------------- - �---------------------_ --/-� ---- \ �) ---------------------------- Phone-,Z; rl �1--7 I Contractor's Name-.- ---: _6r ---•---P , �5 I Commercial Trailer Court ❑ Motel Q Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Number of 4riag units:.--Z--Number of bedrooms -------- Number of baths,_ Lot size ---- - .5-----•- Z ' Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. I`,Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam El Clay ❑ Adobe�f Hardpan ❑ a Previous Application Made: Yes ElNo F-1New Construction::Yes E] No [_1FHA/VA.Yes [-INo ❑` l TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) t S t- a Distance from nearest well-----------------Distance from foundation--------------------Material--------------------.---------------------------- No. of compartments------ -------------------Size----------------------=---------Liquid depth--------------------------Capacity------------------`- isposal� ' :f Distance from nearest well--&A9___-Distance from foundation--- .9-_ Distance to nearest lot line,75'-r----_. Number of lines__------- __ ___ Length of each line-_,20--_-- Width of trench-.-,;2 ( �iit (----------------- Type of filter material_-- 4/----Depth of filter material---.-�0- --____--Total length------' ------------------------ eepag Distance to nearest well---/Q-0--------Distance f om foundQation_� ____--_--.Distanc`P nearest lot dine--0--�.----- Number of pits-_----/------------Lining material_ _ Size: Diameter-__, Depth--. ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------.------------_______---- ❑ Size: Diameter-`--------------t------- - -----------Depth_------------------------------------------------.-Liquid Capacity---------------------------- gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------------------ I ElDistance to nearest lot line------------------- ---------------------------------------------------------- - � -------- -- ---------- ----------- ------- - ------ Remodeling and/or repairing (describe: - _ fes_________________ o ---- ----------------------- ---- ----- ----------.---- ----------- -- --- ------------------------------- ------ --- -- - -- --- - ----- --- ------------------------------ - ------------------------------------------------------------------------------------------- ---------------------------- ------------ I hereby certify that'il have prepared this application and t e work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations +11110 an oa Local Health District. (Signed)------------------------------------------------t R ------------------- --- O ner and/or Contractor) (Title) ---------- ----- - ---- -- - --- ---- ------ ---- By:---------------t-------------- ----------- ------------ ----------- -- -- ---------------- (Plo+ plan, showing size of lot, location of system in relation to we S. buildi s, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------ I-------- ------- -------- ------------------------------------------- DATE----------- -------- ----------------- REVIEWED BY----------------------- I ---------- DATE -. --------------------- ---- - BUILDINGPERMIT ISSUED---------------------------- ---- ---------------------------------------------------------------- DA7E--------------- ------------------------------------------- Alterdo and/or commendations------- -------------------- ----- -------- ------------------------------------------------------------------------------------------------------------ r - --------- - - ------ ---------- ----------------------- --- ---- AJ----- -- ---- - - - -- ------8,19.v- qi& , `� --- -- ---- . ---- --- - -----------` -!---- ------------------------------ FINALINSPECTION BY----------------------•---Y------------------ • ----------- 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 Revised 1•57 F.P.CO.