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APPLICATION FOR SANITATION PERMIT Permit No. .Q._ !!_.-_.. (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. S49. JOB ADDRESS AND 10 TION.:______ _ __-_ . --�.._ ..----- --------------------------------------------------- Owner's Name iF `t , �L�- – ------------------------------------------------- Pho Q Address------------ 7L----- - -- ----- ----------------------------------------------------------------- - Contractor's Name----- ------T'--T�-- - Phon �17 .. Installation will serve: Residence W/Apartm�nt House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - 1.. Number of bedrooms-_ Number of baths __`__ Lot size ------------------------ Wafer ----------------- -Water Supply: Public system EeCommunity system ❑ Private ❑ Depth to Water Table __-.-. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ x 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.) t S` tic T Distance from nearest well-----------------Distance from foundation--------------------Material------------------..--------.._------------ No. of compartmenfs--------------------------Size.- _------------------•-------Liquid depth------------------------._Capacity------------------- osa Distance from nearest well.n4'k--__.Distance from foundation___.r _,*Distance to nearest lot-krie`__��_/_ Number of lines____ _____ __ ____ ______'Length of each line--- __0___f_ 4_ Width of trench.-co f- -------___._--. Type of filter materia �___._Depth of filter material_______!_-___ Total length____a _D____.__________________ Seepage it: Distance to nearest well____ Distance r moundation___-7-0______.DJ�' to ey�to nearest lot line---.I -_-. Number of pits)____/----------___Lining material _ _ ___ ___ ____.._Size: Diameter___�.J_� __.Depth------ --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------.Lining material__.---------------------------------- F-1 _ .----_______._________________❑ Size: Diameter-A--------------- ------ -----------Depth---------------------------------------------------Liquid Capacity------------------ ---------gals. Privy: Distance from 'nearest well------------------------------------------------- from nearest building----------.-_-_-_______.__________.___.._- ❑ Distance to neairest lot-line--- - ------------------------------ ------------------------------------------------------------------•--------------------------•-------=- Remodelingand/or repairing (des' ibe):--------------------- ----------------------------------------- -------------------------------•-------------------------------------- i----------------- •-------------------------------------------- ---i , ------------------------------------ ----------------------- •------------------------------------------------------------------------------------------------------------•--•------------------------------------------------ I hereby cerci y that I have prepared this application that the work will be done in accordance with San Joaquin County \ ordinances, Stat ws, anArl s and regula ' o the n Joaquin Local Health District.Si nedg }---------•------------ --�- �--;--------- ----�-----�-- :_ ------- ---- ---------- --- --- -------------------- --------�r Contractor) r By:-----------------------------------------•------------------------------------------ (Title)-- (Plot plan, showing size of lot, location of system in.relatio o wells, buildings, c., can be placed on reverse side). r FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- - -- DATE----------rte' REVIEWED BY DATE- _ BUILDING PERMIT ISSUED.. 1� ---------------------------------------------- DATE Alterations and/or recommendations:--- -----U----------------------------------------------------------------------------------------------------•------ •--••----•--•-------- ---------------------------------•----------------------1-•---------------------------------------•---------------- •------------------------------------------------•-------•-------•---------------------- ------------•--- -----•--------------------------------- ------------•---------------- ------------------------------------------------------------------------------------------ -------------------•----------------------•--- i FINAL INSPECTION BY:.-_Jl- - ----------:--------------------------- 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 ES-9-2M , Revised 1-57 F.P.CO.