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APPLICATION FOR SANITATION PERMIT Permit No. / I (Complete in Duplicate} Date Issued --- - herein f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here described. i This application is made in compliance with County Ordinance No. 549. r -- Y-------------•---- � -JOB ADDRESS AND LOCATION_-_' Phone � j -- ------------ --- - ------------------------------------- Owner --------------------------- Owner's Name------- -------- Address. -•- Phone-- - -0- Contractor's Name`---------------•---- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Lot size _-- . -- - _ " Number of baths ._ ------ Number of living units: __/__ Number of bedrooms _ Water Supply: 'Public system �ommunitYsystem ❑ 'Private ❑ Depth to Water Table deft. Character of soil to a depth of 3 fee+: Sand F1 Gravel I] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ T No F9New Construction: Yes F1 No ❑ FHA/VA: Yes ❑ Na ❑ Previous Application Made: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool.permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from fodndation.--i----de th_"Material__-- Capacity_._______.__.___.__.."" ptic q p• No.:of compartments------------------------- Size 97 i p' pawl 1d: Distance from nearest Well---- -----------DL Stan of from line ation_"- "" """ Width ofDistance tfrench est lot--ine----------------- Distance _-_--____----• Number of lines Type of filter material---------------------.-_-Depth of filter material------------------""---Total length____._______________________.------`--- ;, /0.---•__..Distan e to nearest lot line Seepage Pit. Distance to nearest well__"a_L11'�"Distance Brom foundation__. Depth- ' Number of pits__I________________Lining mater;al__ __ Q.C� -Size: Diameter___-.�- p G Cesspool: Distance from nearest Weil__--______------Distance from foundation-------------- Luning ing material gals. ❑ Size: Diameter--------------------------------------Depth-------------------------------------------------- q Capacity -------- Privy: Distance from nearest well-------------------------- Distance from nearest buildin ----------------- ❑ Distance to Nearest lot-line------------------------------------ ---------------------------------•----------------------"-•---------•-------------------•--- --------------- Remodeling and/or repairing (describe):____-- -------------- ------------- ---------- i ---- ---------------- -- - -----------•-----------------•---- -----------------------------------------------•------------- ----- -------------•-------------------------•--------I,--• -----=---------------- I hey ify +hat I have}prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances 5ta}e s, and rules and regulations of the San Joaquin Local Health District. -- - rd94p,Contractor} --------------------------------- Si ned ----M- ----------- -- � --------- - By' `' ----------------------------------------------------- mbuildings, c., can be placed on reverse side). (Plot plan, showing size of lot, location of systein .relation wells, F FOR DEPARTMENT USE ONLY ------ DATE-------- - ' „ / APPLICATION ACCEPTED BY----------------------- �------- ---------------------------- -------•--- DATE------ -�•�-----------"7�_-- -:-•-------- 1\ 4 REVIEWED BY -- ----- --- DATE--------------------------------------- BUILDING PERMIT ISSUED__ -- �� ""' ----------- Alterations_and/or recom ion y � - "'. .._._. _! !/[/f�! { .�_x(tom. ..v �' �Y ------------------------- -- -" _' = -------------------------------- `ems -'_:�..,'----'.�--- _____ ------------- ------------------------ ________.. ____________________________________________________________ _____________.___-_.----------------------------------------- ------ y Date------------ =_._.. FINAL INSPECTION BY------ -=----- --------------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 13Doume South American Street 30D West Oak Street Tracy, California 1 Manteca, California Stockton, California Lodi, California t ES-4--•2M , Revised 1.57 F.P.Co.