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r `APPLICATION FOR SANITATION PERMIT Permit No. - -` -------- s (Complete in Duplicate) Data 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_{s.made in compliance with County Ordinance No.1549. F '% • t ___ -_-.___-_.-^----------------"_----__-_--- ._..__.-..---__-_---.___ JOB ADDRESS A LOCAT[Gkk.------"----------`--4-Z ' j : - - - ------------- ------ ----•--- ------------------------------------------------------- ------ Pho -- ---- ••�- Owners Name.---- -----•-- - ,. ,. ------------- --------------------•---------------------•----------------.---------- r� kr - Address----------------v! --•-- -• _ :_ ` --------•- e.. Phon ------------------------ -------•----------------------------------- - , Contractor's Name.__ -.--____ - - ..- Installation will serve: Residence [t Apartment House ❑ Commercial El Trailer Court E] Motel ❑ Other C1 } Number of living units: --/----'Number of bedrooms ._Z Number of baths ---I--- Lot size __._._ J 7'�--------------------- Depth to Water Table---=-- ft:' -'�` Water Supply: Public system [Community system ❑ Private ❑ Dep. # � `� i s Gravel Sand Loam Clay Loam .❑ Clay ❑ . ! dobe 0'Hardpan ❑ Character of soil to a depth of 3'feet:F Sand ❑ ❑ Y ❑ Y s E] No. New Construction: Yes Previous Application Made: Yes No ❑ a; FHA/VA..Yes E] No El - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted::if ublic s'w�er is available within-200 feet�I 4Z_S 4! .0 Septic Tank- Distance from nearest well--_.------_ _ istance�from foundation._- `;--------__..Mat f--'-=-__Ca Capacity---- o fe - No. of compartments---- �`f �Size_Q __ .: Liquiiddep.tb-,-�-1 P Y �i/ istance to nearest lot lin � Dispos l'Field: Distance from nearest Distance from-fou '- �--- - Length of each lines? - -� Width of trench-------- -- --- ---- Number of lines__________ _�_ -1-- �. ��D .. { ` Total length.: [_ 'r ` 4 -,µ "______-_ • e th of filter material_._.-__ ______ Type of filter mate i P — ,l _'. ..,,. Distance from foundation ___�_-__'i_'___==".Distance to nearest lot line_______..____. __ Seepage Pit: Distance to nearest well __ .____ --- _ a-1 Diameter_ "____________________.Depth___-- ---- ---- ❑ ------------ Number of pits------4t ..-- ....Lining material._: ---.----- .---... 4 F w Cesspool: Distance from nearest well-----------------Distance from foundation--.-: -_ -_ --.Lining mater�al__-_.---------___-______-""__.__.___... 4 11 ,_De th___ ----------------- El -- ---- -- 11 Liquid Capacity - gals. . ❑ Size: Diameter -- -------------------------------- F c 1 i 4 Distance from nearest well.--.---___----____--_-_---------------- `---Distance from nearest building--------------------------------:._ _. Privy: - ---•---------------- ------------------------------------- A �. _ _- J. ❑ --- ...... ` �� -• � Distance to nearest lot Line.-�M------------------------------ Remodeling and/or repo ring-(descyibe�: _ _ ;__:_ - -------- a ---------------- .----- --------------------------------------- 11k! ; --------- ---------------- -- 1 i ; t -------------------- I hereby certify that I have prepared this applica#ion and:tha# ¢}rework will be done in accordance with San Joaquin County ordinances, State-laws, and rules and reg ations of the S Joa its. Local Health District. }. " __.(Owner and/or Contractor( ---------------------------------------------(Signedl- _ '----------- r 1 I ------------- ----------- - -----------------(Tit e By:-------------------=-"----•----•-----------•--------------- -, (Plot plan, showing size of lot, location of system in relation to�ells, buildings, etc., can be placed on reverse side). --------------- t ' FOR DEPARTMENT USE ONLY .� DATE--- ----- ---- -----•---------------------- I APPLICATION ACCEPTED B. t ------- --- ------- ---- -----:--------------------------------- DATE_ REVIEWED BY-------------------------------- ----------------- ---------- -- ----------------------------------------- DATE--- t BUILDING PERMIT ISSUED---------------------------•------ -----------------------------------•----------- -" t - Alterations and/or recommendations:-------- - t ••-------------•---- ---•-••-------•---------•--- \j I • } _______ -------- FINAL INSPECTION BY:------ - - - -------------------------- - Date --------------- ------ " SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. E5--9-2M ftevisea 1.57 F.P.CO.