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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __�/:�_Al----- Application is hereby made to the San Joaquin Local Health District for a permit to cons rucf and install the work herein described. This application is made in compliance with County Ordina-nce No. 549. -----------•----•-•---------------------------------� JOB ADDRESS AND LOCATION------------ --- ---- -------------- Owner's Name ------ -- - ----------- - --- -------------------------- Phone----•------------------------------- Address------ ------------ -------- Contractor's Name----------- --- - - --- - -- ----- -----!/----- -_ Phone e. Installation will serve: Residence NApartmen ouse F] Commercial E] Trailer C urt F] Motel Other ❑ Number of living units: - -----_ Number of'bedrooms �__ Number of baths _ _____ Lot size --------------------- Water Supply: Public system Community system E]_Private [-] Depth to Water Table:?dft. Character of soil to a depth of 3 feet: Sand El"' G;ravel F1' Sandy Loam F] Clay Loam Clay E] Adobe K Hardpan E] 0 Previous Application Made: Yes E] No kr NewXbhstruc-tion: Yes,11*' No El FHA/VA: Yes 0 Nc "I e - - 5 TYPE OF INSTALLATION AND SPECIFICATIONS-: '-(N6'septic tank-;r-Z�ssp—ooI`permiffe% if public sewer is available within 200 feet.) eptic Tank: distance from nearest we-11-----------------Distance from foi)nclafion-------------------6Maferial------------------------ -------------------- EE11 r No. of compartments----------------- --—-----Size------- ------------------ _-Liquid depth -----------------------Capacity----------------------- Disposal apacity----------------------- 1 14 Dispoa] d:,. Distan�e from nearest we�i-------- --- IfN s ------- D gatnc�e m�fpundafion___'�:-------------!Distance to nearest lot ine-.--------------- Len*4 Nur8er of lines----- I---------- -- --- - - th of each ---XL�--------Width of french-----______-____------ ------------ Type' of,filter material_____ Depth of filter material_ :_'��, Total length-________________------------------ 1, , f 11 P S7 Pit: Dista'nceNto nearest well_-;,_-L-2f-._____Distance from f9dinclatiou!:----�_ is'tance to nearest lot linQ�- Number of pits-----!/I------------Lining materiaL,,/_7rj-_Rfy_ /(----Size: Dijy-Kete1 __ r__ 51.. ........Depth---- ---- ------- -- Cesspool: Distance from nearest well____________.-.-_Distance from foundation_____- ----- -_..Lining material-__._____________._____________.._ Size: 'Diameter------ -----------------------------Depth-------------------------------------- -------------Li I I quid Capacity----------------------------gals. Privy: Disfance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Fl——Disfancts fd,ne5r6WIof line-------------------- ---------------------- - -•Z---------------- --------------------------------------------------------------------- Remodehnq- 7--r�,repa --------------------- ,1' a-ri-ad/or ing (describil) --------4_e4�� • ---- ----------- ------ -- ------- --- ------- Z-----------------•"----------- ------------------------------------------------------------------------------ -------- --------;-----------I--------------- -------------------- ----------------------I--------------I------------------------- //--------------------------- -- ------------------------------^----------------------------------P--------------------I -- ---- ------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------- � I hereby certify that I have prepar d this ap I*cati 1 and 'at..Ab work will be done in accordance with San Joaquin County ordinances Sfa_f4 I Wi and rulesn 696 , 1affion A -San oa/qu'in Local H alth District. __X---- -- ----- -x- (Signedl --- ---- - ------ ------•--------------------------- ..... wrier an Contractor _an4/p, C By:------------- l - (Tifle �- - - l- (Plot plan, showi size o 101 location of stem in relation to wells, buildings, etc., can be lac on rev,erse'sd FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-N...T7j7 IAJ OA' --------- -- ---------------------------------------- DATE------3-`-- _-��----------------------------- REVIEWED ATE------- REVIEWEDBY------------------------------------------ --------------------I---------------------------------------------------------- DATE------------------I------------\ 4 BUILDING PERMIT ISSUED------------------ E---- -,--f-:---,, ------------------------------------------ --------------------------------------- BATE'_"_-- ------- Alterations and/or recommendations _ - - ---------- ------ ----------------------------------------- ------------ --- ---- - - ---- ---- ------- C, ---------------- --------- ------ ------- "U-AR- --- ------------------ --?<------- �T t� - p - ------------ --- ---- - -------------------------------- -- ----- --------------------------------- -------------------------I ----------------------------------- ---- -------------------------------------------------------------------------------------------------- ----------------11?0!------------------- - -------------- ----------------- -------------------------------------------------------------- ---------------------- ------------------------------------------------------------------------- FINAL INSPECTION BY:_____` ---------- Date-------- ------ �)---- -------------------------- ------- -------- --- 7 SAN JrAQUIN 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.