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APPLICATION FOR SANITATION PERMIT Permit No. .f4_�� _7___. (Complete in Duplicate) VI � f Date Issued ._- I _� ____ 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 'n compliance with County Ordinance No. 5449. �/ JOB ADDRESS AN LOCATION �>� __ __ _ - I Owner's Name----- -01*4_.------- Vx_:e t= L `r' , '"�' ' ---------- Phone------------------------ Address---------- --------------------------------------------------------------------------I----------------------- Contractor's Name--- i'� __A,0;4,r' - Phone.... v Installation will serve: Residence ❑ Apartment House ❑ Commercial M Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _______ Number of baths Y_(_____ Lot size` .______________________________________ Water Supply. Public system ❑ Community system'❑ Private.�, Depth to Water Table Y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,E Hardpan ❑ Previous Application Made: Yes ❑ No k New Construction: Yes, ] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frorn nearest well____-_-------Distance fromfoundation_____ _ ____..Material__________-._____--____:__ ____:___ ,d --'' No. of com artments__._� _____________ Size $ _ — _ - ___Liquid de th____! _ 1v3'____--___ _-_Capacity-) Disposal Field: Distance from nearest well._/__��___-------Distance from foundation__AQ---':- _.Distance to nearest lot line: ______. Number of lines--------;!--------------_I_--_------Length of each mline----=QQ_p------------------Width of french.�`1-------------------------- .-. ' Type of filter material _ /�_'P�-___Depth of filter aterial----? _' __- '_- _ '_Total length----1.d_______________________________ Seepage Pit: Distance to nearest well___ --------Distance_from foundation_�.:�._.____..Distance to nearest lot line_��-------- Number of pits----><_---------ming materiae-__.Size: Diameter__-31-------------Dept h_.___ _�__-_-i-------------------- Cesspool: Distance from nearest well .-_,___`-e-Distance from foundation-------------------.Lining material _ material-__---__--__----------___-_--__-_ ____. ---- ----------------- Capacity gals.DepthSize: Diameter-_- .- ___ -. ---------------- Privy: Distance from nearest well" D ____________________________________ sance from nearest building___-_______--------___----____--_-_______- ❑ Distance to nearest lot line_ t-------------------1_-___-___` — .:: - !7-- /or ------------------------------------Remodeling and repairing (describe: ----------------------------------------- ---------•---------•---------------------------------------------------------------------------- f ` ` _- ------------------••----------------------------------------------------------- -----------------------------------------------------------------------------------------------•------�----------------•------------------------------------------------------------------ ------------------------------------------- ---------------------------------------------------------------------------•-•--•------• ---------------------------------------- ------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, nd r es and re ulation-s pf,the San Joaquin Local Health District. 2. 4 i ' (Signed)--- ----=- ---------- --------------- ---- -9-- ------------- --- ------------------------------------- ------------------------------------------(Owner aCanton,a _r --- ) By- -- -- -- ------- - ------------------------------------------------------{Title)------ - -------- (Plot plan, sh g size of lot, I at on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------------------------------------------ ),DATE " - . REVIEWEDBY----------------------------------------------------------- ------------------------------------------------------ DATE--- ------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------- ---- DATE -- ------------------ Alterations and/or recommendations:------------------------------- ----------------------------------------- -------------------•-------------------------___------------------------------------ 4 -•-----•-•------------------------------•---------------••-----------------------------------------------------------------------------•------------------------•----•------------------------------------------------------ --------------------------•-----------------------------------------•---------------------------------------------------------------------------------------------------------------•---------------------------------------- ------------------------------------------------------------------------------------- --------------------------------------------------------1-------------------------- INSPECTION BY: Date------ `r --------- 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-7-2M Revised 1.57 F.P CO.