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APPLICATION FOR SANITATION PERMIT Permit No. —/------- (Complete in Duplicate) sued Date Is Application is hereby made to the 5an`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. j JOB ADDRESS)AND LOCATIO 7 � - Owner's Name4 � __l ;6n, ``-� - 4 r� I Plione - ----- Add ress----------rJ F :.. --�--�---:-•-- ._- Phone Contractor's Name----------------------------------------------�C.Cf- ------------------------------------------------------- Installation -----------= -=---"Installation will serve: : Residences Apartment House ElCommeef +is❑ �;,�Trailer_Court E] Motel ❑ Other �. p Number of living units• - - _ Number_of bedrooms _ _ Numbof.baths'- -. Lot size ------------------- �' ` crlOft�v Water Supply: Public system [n" Commuriity system'❑ Private Depth'to Water Table Character of soil.,to a depth of 3 feet: Sand E] Gavel 0 Sandy Loam [I . Clay Loam E] Clay El Adobe Hardpan [J Previous Application Made: Yes ❑ N: New,Construction: Yes []�?No FHA/VA: Yes ❑ No ❑ TYPE"OF INSTALLATION AND SPECIFICATIONS: (No{ septic p �from e e r well ,P__ ewer is available within 200 feet.) se ticaank or cess ool ermined i��c-sem � ., _ �' � (��: _.Materia _____ _ ___ ..�__ _tn' P om foundation_____ Se tic Tank: No.-of compartments Y' _---- F D Bance fr Liquid depth____.--------------Capacity. a.• Disposa Field: Distance from nearest welL_: Q-_--Dist nce'I . on_ _. Distance to nearest lot b Number of,lines__ __ __ _Len th of..each line_:__:` _ :Width of french. . '. g Type of filter material- _ - -Depth of filter material fes Total length--- ,5 Seepage Pit: Dis#once to nearest well`_'--r_'.�-----r-Distance from foundation-------------------Distance to ndares ohne--___ El Number of its -Lining mate`rial----------------:--"--Size: Diameter--------=,`:---------Depth--------------------------'---- Cesspool: Distance from nearest,.well_-----------------Distance from foundation_-.----I-----------Lining material------------------------------------- r ❑ •i ePth---=----- -------------------------- ------`------Liquid'Capacify::=-------------- gals. �V Sizer Diameter -- --_--•.--=- '�---.D __________________Distance from nearest building � ------------------. Privy: Distance from nearest well-------------------------- ----- g----------:---------- - Distance to nearest lot line..._ p ❑ - -- - N " s* , Remodeling and/or repairing (de bribe : .a. - � - ''- � _ ----------------------------------------------------------------- =---------*---=---------------------- __ -------—------------------------------------------------------------------------- �4' --------- ------------- ------------ ----------'-------- ------- ------ '----- ---------- jj F . I hereby.cerfify that-11 have-pr.6pared this application and that the work will be done in accordance with SanJoaquinCounty ordinances, Sfate laws; and rules and regulations of the San Joaquin Local Health District.; Si nod '----- h------------------ Owner and/or Contractor) ----- --- - - l ------------------------------------- ------------ ------ : •-• (Title) (Plot pian bowing size of lot, location.of system in relation to wells, buildings, efc., can b�placed.on reverse side). s ' ' FOR DEPARTMENT USE ONLY - x APPLICATION ACCEPTED BY-------- ---------------- -- } DATE DATE _ REVIEWED BY---- •------=•-- ' - f - --- --------- .. BUILDING PERMIT ISSUED- -- w: -- --- ---- DATE-------------------------'------ --------------------- ---- --- Alt 'ons and/or.recommendations:- = ------ ------------ --------------------------- -1k . :Z.:: --- ----------- --------------- ---------- "v a ------------------ t _____ _________________________________________________________ - - ______________ ------- ---------------------- ------- ----------- ------------------------------------------------- FINAL fNSPECTION BY:.-- x• .�::" � �-------------- -- - Date---- --- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 5-57 F.P.CO.