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APPLICATION FOR SANITATION PERMIT Permit No. G------ 1 (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 he ein described. This application is made in complian ith ou y O anc 549. <G �G/7 , ---f_-� ----- JOB ADDRESS AND LOCATION-- �'rY� 1�� {;1 '-.�- ---------j -- ---��- ---------•-------- Owner's Name--------- — I1--. Phone---------------------------- -- Address-------- ..., �� C ----------------------------•---------------------------------------- Contractor's Name-------..-•--.- -=- ----------------------------------- 11--- Phone----.---- Installation will serve: Residence p ❑ ❑ ❑ .I otel ®�ther ❑ . 9 �_ �� --------- ------------------ Number of living units: �_ _.__ Number of bedrooms ____ Commercial Iof baths a.i_er Lot size `-„ ------------------ Water'Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _I ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ i Previous Application Made: Yes ❑ No B` New Construction: Yes ❑ No [H� FHA/VA: Yes I❑ No w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept" Tank: Distance from nearest well-----------------Distance from foundation_---_-__--_------_.Material-----------.-_----.-----_---____---_-_-_-_---__. y 91 No. of compartments-------------------------Size---------------•----------------Liquid depth------------J-1-----------Capacity----------------------- Dis osaFieId. Distance from nearest well.lAl�_.....Distance from foundation----_-r1_'�_-______-- Distance to nearest lot line-----��_'---_---- ' �� umber of lines-_-----0�- ��- ! ------------------- T. N 2�-'._.__.-_-�--/-,I-Length of each line_�`__1�------'--�•�--.Width �of trench.---- ---------------------- ' �� Type of filter material_/�_ -Depth of filter material--/e— -------Total Length----- ;t1-:2 --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---.....------------Distance to nearest lot line----------------_ ❑ dumber of pits----------------------Lining material-----------------------Size: Diameter---------------lM------Depth--------------------------------- II Cesspool• Distance Diameter nearest well---- -----------De Distance from foundation -----------_-----•_LiLining uid I material__________._._._____________________ ❑ p q Capacity----------------------------gals.Privy: Distance from nearest well------------------_____-_..____----_---_--------Distance from nearest bIilding_---------.____-__-__---____-------------. lam' [] Distance to nearest lot line------------------------------------------------------------------------------------ ------1-------------------------------------------------- s -------------------------------------------------------- Remodeling and/or repairing (describe):___________________________ � ---------- ----- ------------------ ------si4----- ------------ �r � . ----------------------------b.fi°=/-+°-E -G"'r'- - -----=-----t��=�=�`='�'�------- ---�_r.� -� - -Ute`--- ��---�"' '-R -------------------- fj _ ' "✓ /2�1 !--- ---•-------------------------------------------------------------- ------------ ` I I hereby certif that 1 have prepared this application and that t'he work will be done in accordence'with San Joaquin Coun ordinances, State laws, a d rules and regulations of the San Joaquin Local Health District. ! ( g ) _ '�Bwrterarrdfnr Contractor) Si ned r - --------- . -------------- --- �� '— (Title} ,�y� 7' -- By: ^ (Plot plan, showing size of lot, I ation of system in,relation to wells, buildings, etc., can be placed on reverse side). ,M FOR DEPARTMENT USE ONLY �� I APPLICATIONACCEPTED BY------------------------- -------------- --------------------------------------------------- DATE------ -------------------------------------------- REVIEWED BY--------------------------------------------- ------ ------------------------------ --------------------------------------- DATE----------- = - /----------------------------- BUILDINGPERMIT ISSUED------------------- --•------------ ------------------•—-------------------------------------- DATE-------- �� 1- ------------ Alterationsand/or recommendations-------------------------------- ------------------------------------------------•----------- II �-----------------------------•-- �---•-•----------- IM ------------------------•------------------ ---------------------------------------------------- IM FINAL INSPECTION BY:.-------- ---------------------- Date---- -- ----------- �r - 1 / . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street :a I ;$14 North "C" Street Stockton, California Lodi, California Manteca, California <, ,Tracy, California --ES--4-2M Revised 1-57 F.P.CO.