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APPLICATION FOR SANITATION PERMIT Permit No. ........ (Complete in Duplicate) a� r 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 Courity Ordinance No. 549. /'.j� •� .. JOB k)DRESS'AND LOCATION----- ( f� �!274 i' �-C ,Jt_ -)------------- ------------------------------- Owner's Name----------------------------- �- f -4r►-r-�,�.-------�v-�-�--�-�-�`�------- - --- ---- --------- -----------1---------- Phone �----�-�r--(d--�-� ----------------------�6 ---�---- _�� - -'�------------------------------------------ Address----------��-------• ---------------------•----------------------•- Contractor's Name----------------------------------------- -------------------------------------------------------------------•--- Phone----------------------------------- Insfallafiion will serve: Residence g Apartmentt"House ❑Commercial ❑ Trailer Court ❑ Motel [] Other ❑ s . � ..._ - ,SoX /o0 Number of living units:•__,____Number of bedrooms .___Number of baths __!_-__ Lot size _______.___________________---------------._________________ 19 1 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamR Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes 9 No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank. Pr cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest weld___:___________Distanc1e�frompfoundation---Za-----___'M�rial__�______________________________________ No. of compartments_________._______; ize_-__.'7rxR-X_ __Liquid d,pth__;____�_________________Capacity._____--- Dis osal Field: Distance from nearest welIA&I.----____Distance from foundati tt Distance to nearest lot lin z------ r p ,p f� --------y- �f � Number of lines________ _ __ _ ______________Length of each lineJ_r_'t'_):Z_7i of 7_..Width of french---------.7►_ Type of filter mate ri�ip g De th of filter matenal____.__C__�_--__-___Total;len th__________ -------------- Seepage Pit: Distance to nearest well----- .-+--_---------Distance from foundation--------------------Distance to nearest lot line_________________ t ❑ Number of pits----------------------Lining material----------.------------Size:,Diameter---------k-------------Dept h--------------------------------- i 1 \� .Cesspool: Distance from nearest well--------_--------Distance from foundation--------------------Lining material________..__________-_______________ N ❑',�. ,� Side: Diameter------------------------------------Depth--------------------- Liquid Capacity g ----------- als. Privy: k Distance from nearest well_�"___________________________________________Distance from nears building-------------------------_-_--------_ --- El Distance to nearest lot Iine--------------------------------------------- - ---- -------------------------------- -1 Remodeling and/or repairing (descril,e� -------------------------------- - I ---------------= ---------------------------------------------------------- -------------------•------------------i------------------------------------•---------------------------------------------------------I---------------------------------------------------------------------------------------- -------------------------------------1 --------------------------------------------------------- -------...------=---------------------------------------------------------------- t-------•----- I ------------------•------ -------------------------------------------------------------------------------•------------------------------------------------------------------------------ I hereby certify ttat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and...rules and regulations of the San Joaquin Local Health District. (Signed) " ` ~---------------------^--- -----r-(Owner and/or Contractor) 13y:------------------I--------------------------------------------------------------------------- -- - I---------(Title)--------- ---- (Plot plan, showing siz 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,97:------------------------------------------ - 1 REVIEWEDBY------------ #---------------------------------------------------------------- DATE_:�E-------------------------------------------------- BUILDING PERMIT ISSUED--- -- --------------------------------------------------------------------- DATE---__U-1-------------------------------------------------- Alteratioisynd/or-cecomm d tions---------------------------------------------------------------------- r 1=� -- _ ,.__ --- ------- S _�/------------ 11-_�� I ------------------------------------------------------------------------------------------------------------------------- ---------------- - - -------------------------------------------------------------------------------•----------------- --------------------------------------------------------- a t FINAL_ INSPECTION BY:-------- G Date_ Z ------------------------------------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, CaliforniaManteca, California Tracy, California _ E ES----9--••2M , Revised 1-57 FRCO. 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