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.3 � � l- tc � r✓ 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 OCATION_--- ---------------------- / Ile,Owner's Na -----: �[ --._C._= ---- Phone------------------------------------ Address--- -f_.�/ -� - Contractor's Name--------•--------------------------- -------- -------- Installation ------Installation will serve: Residence ❑ Apartment House p Commercial ❑ TrajileZAbourt ❑ Motel ❑ Other ®'. v - .�a Number of living units: ___.____.Number of bedrooms -------- Number of aths`dli_ Lot size -��.� ____________________________ Water Supply: Public system ❑ Community system [IPrivate Depth to Water Table ,!' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EY--Hardpan ❑ Previous Application Made: Yes ❑ No R----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.) f Septic T rtk: Distance from nearest we4l- CQ_f_tDistance from foundation---/Q Mate [! No. of compartments-------- -------------Size_- .5 ---------Liquid depth--- Capacity- p �......... Distance to nearest lot line----�--_-_- i Dis osal F• Id: Distance from nearest well __LfQDistance from foundation_ Number of lines-------- _ Length of each line___'s�.Q_.`---_-.��__-Width of trench.--,2--X-/ Type of filter material__Sr__. _. Depth of filter material_-_._ ---------------- Is - --_-.- Total length----__--__---_-'-�----------------- r ! � Seepage Pit: Distance to nearest weIIOQ. _._7 __Distanc�e� om fo nciation_re4________.Distance to nearest lot line__--5�______._ Number of pits._-__-/--_-.---_- Lining material:I _Size: Diameter----_-3-3-11-----Depth___,&:----J____--_______________ Cesspool: Distance from nearest well-------- ------Distance from foundation--------------------Lining material----------_____---------------_ El Size: Diameter----------------------- --Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------- Distance from nearest building------------------------------------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing [describe]:__._�'_{�L�V. _< - R1 1 ______ )E _I v_i Fa -----____ LFI-_-_-AR- —I`}_______- ----------------------•-------•----------------------------------------------------•----- ---------------------------------------------------•----------------- --------------------•-------•----------------------------- .r --------------------------------•-------------------------•-----------------•----------------------------------------•----- -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Siete 11a s, and rules/ and regulations of the San Joaquin Local Health District._, (Signed) V $ � --------- ---- ----- (Owner and/or Contractor) BY: ----------------- ----(Title)-- ---- ----------------------------- v---- - (Plot plan, showing size of lot, location of system in relation to w Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------- ------------------------- --------------------------------------- DATE----------5-`-7!0.7-6-P REVIEWEDBY------ ------------------------------------ - ---- ------------------------------------------------------•-------------------- DATE-------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------=---------;------------------------------- DATE , Alterations and/or recommendations:---------------------------------- ------------------ ---- --- ----------------------------------••-------------------------- - ----------- --------------------------NQ-�-_--_--_F---5-7Ap '------T.-�K-.�•-_-_-_ ------------- Q FINAL INSPEC ----- -- -- ----- --------------------- ----------- --Y��L Date------ �-"-�--^-� � ------------------------------ ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO. 1