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APPLICATION FOR SANITATION PERMIT Permit No. ._9G.f..... {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 herein described. This application is made in compliance with County Ordinance No. 549. JO B ADDRESS AND LOCATI N G� ------------•----------------------------------- - _ --- - ------- ----------------------- Phone--/-6419 Owner's Name ` } --- ?` . Address---------- -! ---- ---- ------ -- -- ------•---- `{�------ ---- ---------- - -------------------- � ---- Contractors Name-------------------- -- Phone._. Installation will serve: Residence Apartment House Commercial Trailer Court ❑ Motel ❑ Other ❑ ``'� Number of living-units: ---/--- Number of bloc,s J--. Number of baths ---1_ Lot size ------ ...__ '.. -..------------- .... Water Supply: Public system [ Commuriity system'❑ Private ❑ Depth to Water Table �� ff. Character of soil to a depth of 3}feet:: Sand ❑ Gavel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe�f Hardpan ❑ II Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No" TYPE OF INSTALLATION AND,:SPECIFICATIONS: (No septic tank_or'cesspool permitted if'public sewer is available within 200 feet.) Se fa k: Distance from nearest well------------------Distance from foundation---------------------Material.---- .--------_------------...... / No. of compartments--------=----=----- -----Size---•--•--------------------.-Liquid depth--------------------------Capacity----------------------- D' eld: -A Distance from nearest well------------ --Distance from foundation--------------_-----Distance to nearest lot line_-_------------- Number of lines------------------------------<-.Length of each line...._._------_ ____________.Width of trench------------------.-___._________. t Type of filter material.......Wo Depth of filter material --------------- Total length........._._................. S age Pit: Distance to nearest "'.11 --Distance fr founclation. ----..-__.Distanfg to nearest lot ling. ------ ac ---- (, Number of pits.. J-------------"Lining material.._..f�c.64-0 Size: Diameter-.--13—__.._."....Depth........ ' ..__.._-..- Cesspool: Distance from nearest well-----------------Distance from foundation.....'...............Lining material-.-..-.----.-.-____.-.--------------- ElSize: Diamefer---- ;-----------------------------Depth------------------------------------ 1------ :---Liquid Capacity----------------------------gals. . Privy: Distance from nearest well-----------------.... ..... "_Distance from4n.earest building-------------------------------.._."...... ❑ Distance to rit4earest lot line "--------------------- ----------=------ ------------------------------------- ---------------- Remodeling a d/or repairing escrib ' - e ----------- --------------------- ... .rr ..._ IJP 6 I J �/f - 1 } A I 'r j. ............................................-----...........-------------------...-_."_.-.------...----••-..._--.........----_--....-----.._..-_._....-.-------------._._-.-.-... "._.-"_..-.-------..._.....- I-hereby certify that I have prepared this-application and that the work`'will be done in accordance with San Joaquin County' ordinances, State laws, rules and regulations of the San,Joaquiri.Local Health District. 5i (Signed) an or Contractor) I d,/ may s. ., [Plot plan, showing size of lot, ocat' n of system in relation to s,-,buildings;etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY- --------- -- —---------------------------------- -------------------------- DATE.-------------- �� DATE---- . -- ----------------------------------------- _:I --T------------------------------------ APPLICATION BY----- !� -- ------ ----- - --------- � - -- �-- -------------=------- �' BUILDING PERMITorrecomm�ndaf n 1- �� - DATE } } +" N Alterations alld/ r T l w --t'� R= 0 'a''� '.' b� 4�_Y! 4e"'T Ir..._. u.` M - •-••-- ------------------ �-_ ------------ ----- ------------------------------------------•-------------•- 2,:):------ — - ---------- ------------------------- ------------------------------------------------ w g .. } L ` FINAL INSPECTION BY - -'-_ Date----- --�------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRI T 13P South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revises 1-57 F.P.GO.