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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) - ]_ 4) m Date Issued ---------------7------- 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 Or inance No. 549. F JOB ADDRESS AN CATION l -��'Ln--------------------------------------------------------------------------------- 2 Owner's Name----- -- ----------� ?- - _ .. Phone_,�'O Address------------------ -- --- ------ - ------ - ------- ---- -- ---------------------------------------------- Contractor's Name--------------- -- --------------------------------------------------------- Phone,- ---W -- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _/_ le /-__ Number of bedrooms _ __. Number of baths _-_�-- Lot size .-__. _ f�____________________._-__---_ Water Supply: Public" system Community system ❑ .private ❑ Depth to Water Table,,57/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(]"lardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 0 No [�rFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Ta.k: Distance from nearest well-_�S _:__Distance from foundation___�A---_.__.Mate�ial_.�r�_ _ ______________________ No. of compartments____..._-_/-_.-_------Size----,,� ____________________Liquid depth_--_-!7__4-l�--------Capacity__ . Disposal Field: Distance from newest well__lQ.�_�_Distance from foundation----/E�__--___.Distance to nearest lot 0� Number of lines_-__' ------____________ Length of each line-___`_yf__-.--_____--.Width of trench-___ _ _ _____.___________ Type of filter material--S De th of filter material___.__ /_ Total length___.___ p f - Seepage Pit: Distance to nearest well__/Qp---------Distanc�m f undation____�_a�______.Distance to nearest lot line____5_______.__ Number of pits----' J---------- Lining material_-- _ ---.-- _ Size: Diameter_---J-1.3-,-------.Depth_..._. ------------------ Cesspool: Distance from nearest well..................Distance from foundation------------------_Lining material_____._.----_------._---___----___ . ❑ Size: Diameter----- '----------------e.^ ----------Depth---------------------------------------------------Liquid Capacify----------------------------gals. Privy: Distance from newest we]L_.------------------------------------------__Distance from nearest building--________.__------.----____-________-__. ❑ Distance to nearest lot line_ ----- --------------------------------------------------------------- Remodeling and/or repairing (describl]:__... _ ____ - _ __________________• i' --------•----------------------------------------------------------------------- ------- - i -----------------------------------------------------------•------•-• --------------------------A------------------------------------------ ---•---------------------------------------------------------•------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc fa laws, and rules and regulations of the San Joaquin Local Health District. , (Signed) ----------- --- '- '------ --------------- --------------- --------------------------------- -----(Owner and/or Contractor) B . Y•----•--•-------,---•---------------------------.-------L�.�P��.-- -------- --- - - -- ---- (Title)----- (Plot plan, showing size of lot, location'of system in :elation ells, buildings, etc., can be placed on reverse side). k� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '-L:. �._ � ---- - -------- DATE_.m1� �--(j--------------------------------- REVIEWEDBY--------------------------------------------- --------------------- --------------------------------------------------------- DATE - - BUILDING PERMIT ISSUED----------------- 1----------------------------------------------------------------------------------- DATE Alterations and/or recommendations:__ ____________________ _____._____.____ ____.____ ` ,,. 40 ___________________ _ _ ._____ ____ __K___.yi-.--..___.__.-._._________________________________ __ ._-_______--_ _._ ----♦_-.._-------- //',�,� _ -_ _._K___.__.`____________________________________�,q_Fu_�1 gyp y,�q -__ • 1 FINAL NSPECTION BY:. _..-___ .'.,.�-�" �:��' '�` Date-----°Z`--�--�-�- �----------------------------- ----- -• 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-9-21x1 Revised 1-57 F.P.CO.