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APPLICATION FOR SANITATION PERMIT Permit No. _fd (Complete in Duplicate) Date Issued 10 JYlb �_ --------- 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. 54 . JOB ADDRESS AND LOCAT ON____ --4WIPF-�-__ j ' Owner's Name- - --�� Phone- L Address -------- ------ ---•-- ----------- ------------•------------- - -- Phone----------------------------------- Installation Name �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ ___ Number of bedrooms _ ._ Number of baths y ��Lot size f Water Supply: Publics stem ❑ Community system ❑ Private K<Depth to Wafer Table eft. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes Rq-"5o ❑ FHA/VA: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- 1470---Distance rom foundation-----/ -------- M�ajterial__�6.__ - No. of compartments J ---X-Y-0-_---Liquid depth-___-_!--4 .5 p Size_ - --- Capacity-- Disposal Field: Distance from nearest well/02 ._____Distance from foundation/ ,/�- -- �_!__.___.Dis#ante to nearest lot line__��_ ___. Number of lines--------/'1./-- - ------- ------Length of each line-------- 7-- ------.Width of french----Zk"------------- --- Type of filter material____----Depth of filter material____,Af'"___Total length_____e Z7_________________ __ i A S epage t: Distance to nearest well__`j_Qg Distance from fo ndation____J_0 ..DistancP to nearest lot line___----__ Number of pits___._____----------Linin maferial__ --Size: Diameter___,-__ -----Dept Depth_____e�.j$'_�___ -------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material----------.-----------______________- ❑ Size: Diameter--------------------------------------De th--------------------- ----- - - - -------------- - Liquid Capacity ------------- �-- ----g als. _______________________________.___________-___-Distance from nearest building___ Privy: Distance from nearest well ❑ Distance to nearest lot line--------------------------- --- -------------------------------- 1 Remodeling and/or repairing (describe) -------------Co- _ _ --------------------------•--•-------------------------------•------------------------------------------------------------------------------------------ ----- -------------------•-------------------------------- . ----------------------------------------------------------------•------------------- -------•---------•-- ------------•------------- ----------------------------------------------------------------------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Y ordinances, State laws, and rules a d regulafions of a San Joaquin Local Health District. (Signed)-------------------------- -- ----- ---------- {�Confractor� By:------------------------------------------------------------------ --- ------(Title)------------ L(Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). Fff DEPARTMENT USE ONLY U APPLICATION ACCEPTED BY------ - ---- - - ---- ---- --------------•------------------------ DATE-----------� -•!! REVIEWED BY_ DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------DATE------- - Alterations and/or recommendations--------------------------- ----------------------------------------------------•----------------------------------------------------- ---------------------------------------------------------------•-----------------------•------------------------,,. --------------------------------------------------••--------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------•- ------- -------------------------------------------------------•--------------------------- ---------------------------------------------- FINAL INSPECTION BY:------- . __ - - -- Date---------- )� �`-L1 � 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 , Revisea 1.57 FP.CO.