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<11 «e (4-0007 4. ` APPLICATION FOR SANITATION PERMIT Permit No. ._ 4--_____. .._ (Complete in Duplicate) Date Issued -� d----- A licatian is h�eraVbvy made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th'spapplicatioh is made in compliance with County Ordinance No.rg. 1 } JOB ADDRESS. AN CATION -- •- --- ----- - - - -- f Phone;_ Owner's 'Name- --------------------------------------------------- --------- - ---- ----- I --- Phone Address;- ------ ------ ---------------- -- - ----- r - Phone -- Contractr s Name f: 4 �t` �� ------- --- - - - - -- Installation will serve: Residence Apartment H use ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units:. Number of bedrooms __J_-_ Number of baths __/___ Lot size _-_- srQ-l�---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table��ft. Character of soil to a depth of,3 feet: Sand,❑ Gravel F1 Sandy Loam E] Clay Loam E] Clay (j Adobe Hardpan E3Previous Application Made: Yes ❑ Nog I New Construction: YesX No ❑ FHA/VA: Yes ❑ NOX � TYPE O9, INSTALLATION AND SPECIFICATIONS: ([�o septic tank or'cesspool permitted i public sewer is available within 200 feet.) Geptic ank: Distance from nearest well_________________Distance from foundation-------------------.Material----------------_.-____________________-.-_____. ' No. of compartments-------I-------- --------Size--------------------------------Liquid depth--------------------------Capacity----------------------- �Dispos I eld: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_______________. I Number of lines----- I-----------------Length of each line------------------------------Width of�trench----------------------------------- r ' Type of filter material_____1,-----------------Depth of filter material____-___-----_-________Total length__--_____:_______________________--____-- A Seep e1Pit: Distance to nearest well_ _____Distance from f ndation__ -___-__-Distance to nearest lot line_ _j. Number of pits___-_ __!__Lining materia _ _ �__-Size.: Diameter__-, ______.-.___.Depth__ ___cJ�.__ Q i Cesspool; Distance from nearest well-----------------Distance from foundation--------------------Lining materia!_________ _________________________ ❑ Size: Diameter------------------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. e\ t Privy: Distance from nearest well------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------------- -------------------------- - ------------------------------------ ----- ------------- --------------- „r Remo n repairing [describe: d� �' 1 / f 1 = ! " -=--------------------E------ -------- ---------- -------- ------------------------------------------------------------- __ _____________________________________________________________________________________________________________._----__-_ rI'-hereby certify that I have prepay this application a� that t work will be done in accordance with San Joaquin County rordinance`s; to law. and rules and ulations the S Joaqui oval Health D' ' t. Ow (signed) - f ( d/or Contract or) 6 � --------TitleT n y.------------. p_____'__ .. (Plot plan, shows g size of lot,ilocation of.systemem.relation to wells, buildings, etc., can be placed on re erse e). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------------------ DATE------------------------------- REVIEWED BY--------------------- ------- ---------------------"---= ---- - ------------------------------ DATE-- � --- - -------------------- PERMIT ISSUED-------------------------- -- -- ------------------ DATE----------------- BUILDING Alterations and/or recommendations:-j;_____`__ _ # j i --------------------------------------------------•- i -------------- - - ---------------•------'----- - -- -- ---------------------------- .- 1�� ----- - ---- - - --- --- ----V"-- ----- - - �-_ __------- ---------------------------- - ------------------------------------------- I_-�_._._------------- --------------- ----- f J -- --------- G^-' -. - 3 _ _ __.____ ________-- _________.-._____ ___--_---__.____._._________-.______--____________-_--______-______.-______________________.________--------------------- ---------------------------------- FINAL INSPECTION BY: Date r SAN JOAQUIN LOC L HEALTH DISTRICT 130 South American Street 300 West Oak Stree132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California W ES-9-2M , Revised 1-57 F.P.CO.