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APPLICATION FOR SANITATION PERMIT Permit No. _ d_.. ......... {Complefe in Duplicate) S Date Issued _-lz s 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. JOB ADDRESS AND LOCATION = f/ �f - - . � � Owner's Name-----------!/ -_-__1j=-------- ---------------- - --- ----------------- ---- - ------------ Phone------------------------------ Address 4l ... ------ = �/to Contractor's Name-------------------- --------— /�'✓S'�)�__---Y_ �------------------ Phone----- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court El Motel E] Other E]Number of living units: -__ _-__ Number of bedrooms ,.- Number of baths j____ Lot size ____ -_.krl___--/4-0------------- Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan L]Previous Application Made: Yes ❑ No, New Construction: Yes E] No FHA/VA: Yes ❑ N, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r, Sept' Distance from nearest well-----------------Distance from foundation--------------------Material ______________..______________.___.-__._____-_. No. of compartments----------------------- --Size------------------------•-------Liquid depth--------------------------Capacity--------------------- Dispb4aL-l`ield!, Distance from nearest well_.----------------Distance from foundation--------------------Distance to nearest lot line_fes--------- Number of lines______,l___:__ Length of each line____c QWidth of french__.__�_� ------------ X Type of filter material_-____ _(Vic_-Depth of filter material------- ( _____Total length------aw---11-----------__________ See a e Pit: Distance to nearest well____AleAk---Distance from foundation_-5.-___ .Distancee to nearest lot lin _ Diameter Number of pits.---l_-______ _____Lining material___,/.&__Ce� � Size: Diameter___ �__ _____Depth_._ Cess ool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material________________.______,._________ \ ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. , Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui{ding_______.______________-_______..____._____ ❑ Distance to nearest lot line------------------------------------------------- ----------------------- --------------------------------------------- Remodeling and' repairing Idescribe):---- 61�- --------------------------- i - - -- -----= ---- 3r F 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, and rules and r gulafions of an Joaquin Local Health District. (Signed) -----�- -------------------------------------------(Owner and/or Contractor) 9 )------------------------ --- By:------------------••----------------------------------------------- (Title) (� - � (Plot plan, showing size of lot, location of system in:relation fo well ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- 1W. ------------------------------------------- ------------------------- -------------- DATE----- REVIEWEDBY------ ---------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------- BUILDING PERMIT -- --=- ISSUE-D---- --_---------------,--_ ---.--------------------•---- --y----- -----:-----------------------------------_----_---- DATE ndoret mmendatons:_Alteraons _- ---.____ :::::::::=-----------•---- --- -------------- -- ------- If - ------- 3 -f_oe-----------, e , -- --------------------------------------------------4�---------------- -------� - FINAL INSPECTION BY:.--. Date / [ � 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 E5--9-21st , Revises 1-57 F.P.cO.