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APPLICATION FOR SANITATION PERMIT Permit (ComNo. (Complete in Duplicate) /O ? p p } Date Issued ---------- ----s1--- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fhe work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_______:_ __ +Gll_ ------ -- --�-- r Owner's Name--------- la . = / C� -------- - - Phon ----- Address__.-•------------ ---------- -----------.l - - �--------------- --- Contractor's Name-------- 7 rJ'L� Installation will serve: Residence Apartmense t Hou ----------•------ - ---------------- - ------•------------------------------ Phone_ _._. ._----- E] Commercial [j Trailer Court [:]] Motel ❑ Other ❑' Number of living units: __/--- Number of bedrooms ~✓ Number of baths ---I/ Lot size ---- -. -- r.-?'�___L�:��--�-------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction; Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ,7 TYPE OF INSTALLATION AND SPECIFICATIONS: sepfic tank,or'cesspool permitted if public sewer is available within 200 feet.] Se c Tank: Distance from nearest well-------(_-_______Distance`from foundation---------------------Material-----------------------________-__. No. of compartments---------------I----------Size---------------------------------Liquid depth--------------------------Capacity--- ---- osal FId.�_,-Distance from nearest well______ -----------Distance from foundation--------------------Distance to nearest lot line__--._______..___ r �. Number of lines-----------------------------------Length of each line----------------.-------------Width of trench_------------------ ----- Type of filter material-_______________________Depth of filer material____.____________--_-_Total length---------------------------________ .__ Seepage Pit: Distance to nearest well____i_! - -Distant � � m �°undation_-L_�__-_: ..Distance to nearest lot lin/___ -------- s - Number of pits--- ----------------Lining material _ 5 ----.Size: Diamefer_,3-�_____------Depth.--- ------------------- Cesspool; Distance from nearest well_________________Distance from foundation--------------._,___Lining material-------------------------------------- El _________-_______._________- Size: Diameter...-•----------------------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest iot,line Remodeling ant}/or repairing (describe)----------------- -------------------------,------------------------------------------------- --- ---------------------------------------------------- ---------------------------•-- ------ -- - ---------•----•---------------------------•------------------ "------------------------------------------•------------------------•------•--------------------------------- I hereby ce i y that have prepared t 's appl)ionad fhaf the work will be done in accordance with San Joaquin County ordinances;S#-a d rules and regu ions oJoaqupbuildings, alth District. Sined ��g } --- ------ --------- ------------------------------- Contractor ------ -- BY: ----------- -- --------.(Tifle} -�---_ ----------------------- (Plot plan, showing size of lot, location of system in o wellsfc., can be placed on reverse side). F R DEPARTMENT USE ON Y APPLICATION ACCEPTED BY_-�----------------------------------- --- -- ----- DATE-Z' ................. ___--_--- - REVIEWEDBY --------- --------------------------------------------------------------------------------�---------------------------- DATE_ .- -t----------- -------------------------------------------------- - -------------------- BUILDING PERMIT ISSUED----------------J----------------- -- ---------------- -- ---------------------- --------- DATE-----�-�------------------------------ - aerations and/or recommendations:--------------------------------------------------------------------------------------------- ------- (---------------- ---------- ---- �� / _ �_. Sys � �� --Z-e- -- ---- __.._______ ___.._._._____.__.__-_________--_____.________-_-________._ FINAL INSPECTION BY---------------- ------------------------------ Date---I J { - . 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.