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'1 APPLICATION FOR SANITATION PERMIT Permit N,o- ------ _ `'_7'��°-� • _I)r (Complete in Duplicate) Date ' [ssuecl _ --�r-- 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. 549. e e, it JOB ADDRESS AND LOCATION_.------------ - cam f '4 ----------------- ------------•-- Owners Name----------�-t------ ------ one ;_ Address--------------------- ------ = ------ r---------- ------ Phone- Contractor's Name------------ Installation will serve: EResiclence Apartment House I—] Commercial I—] Trailer Court ❑ Motel El Other [I r -- - Lot size - Number of living:units: Number of bedrooms _Number of baths Water Supply: Public'system Community system ❑ Private F1Depth to Water Table �/Q ft. Character of soil to a depth of .feet:y Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: Yes Ll No New Construction: Yes El No FHA/VA: Yes ❑ No7 TYPE OF INSTALLATION AND SPECIFICATIONS: - -- / (No septic tank or'cesspool permifited if public sewer is available within 240 feet.) Septic 'a kj Distance from nearest well-----------------Distance from foundation________________ Material enal-___________ -------- ---------- No. --- -- No. of compartments--------------------------Size--------------------------------Liquid depph----------------------_-Capacity r' Disp iel Distance fromnearest well_jf��YI��Distance from foundation_ Q-------Distance to nearest lot lin<e, ._.___.___ l -p Number of lines----------- - f Wicifh of trench --------------- L � - ---=- _=� ---length of. each line_-,-��--------i-:---. �--- Type of filter material__ _CX_Depth of filter material----.�,�'._- _____Total length-------- C)-_�-------------- cy r S epa e pit: Distance to nearest well-�___ � -DistaCe r m ours tion___._ a _ Distance to nearest lot line-/-4________ �. �r De th �--------------- �+ Number of pits-_-_ : Lining ma#eri ze: Diameter----- Number __________ p \ Cesspool: Distance from nearest well____________---- _Distafrom ndation__---____.-"---__..Lining material_--.--..__-__---_------------------ ._. � Size: Diameter------°---------- -----` ----------- Depth------------------------------= = Liquid Capacity gals. Privy: Distance from nearest well __`--------------------------------------------- --Distance from nearest building------------------------------ ---------- \ ❑ Distance to nearest lot line--------- ----- ------------•--------------=----------- \ ------------------------ ---` ----------•-----•---------------------------------------------- Remodeling and/or repairing (describe)= ------------•--------•-----------•--------- rL --------- ---------------------------------------------------------------------.---------------------------------------- 1 hereby certify that havel.prepared application and that the work will be donee in accordance with San Joaquin County ordinances, State laws ' rule and egulati s of the San-Joaquin Local Health Distri-cwt--� I ------ ------------- (Signed).. - Owner and or Contractor) Si ned - r s �s ( 9 )•. �_. . ---�- Title ��? �� By:------------•---------------------------------------------------------- P (Plot plan, showing size of lot, location of system in relation to ells,,building (s, etc., can be laced on reverse side). I FQR,DEPARTMENT USE ONLY ` .. APPLICATION ACCEPTED BY------- '`�`I-------- = `�--------------------------- DATE '"�= ` REVIEWED BY---------------------------------------------------------------------------------------------------------- DATE------------------------------------------ BUILDING ---- ----------- --------------- BUILDING PERMIT ISSUED---•----------------------------- ----------- DATE------------------------------------------------------------ Alterations and/or recommendations-------- ----------------------------------------- ------•--------------------------------------•----•--- ------------------------------------------------------------------------ --------------------------- -------------- ----- ----- -- ---------- ---------� J, .. .... ate_ ----- - -------- - -------•------ -------------------------- D •---- .. FINAL INSPECTION BY::.._------'_-- - - 41----"-- ------ ------------ 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 , Revisac 1.57 F-P CO.