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APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) Date issued Application'is hereby made to the San Joaquin!Loc'al Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. ' JOB `ADDRESS AND:LOCATION--------------- ---J"3 ------,- ------•- ------ ----------------------•----- Owner's Name_- ------ ------------------------------------ j Address----------ZJ-3_�--- --------------------------------- Contractor's -------Confiractor's Name • •--••---------4- t -- ------- --- -------- ------ ----------------------------------- - e I--,- Phone Installation will serve: a Residence ❑ Apartment House ❑ Co me�c�61'& Trailer Court ❑ Motel ❑ . Other ❑ Number of living units: ____----- Nuinberof bedrooms ________ IN—umber of baths _______ Lot size -_-___-__:________ ------- Umber Water Su m Supply. Publicsystem Com� �un ity'sy�tem'❑ 'Pr�to E].'.Depth t o, Water Table C�b ft:—Y"' Character of soil to a depth of 3 feet- Sand E] Gravel ❑_7Sandy Loam Ll Clay Loam ❑ Clay ❑ Adobe [f Hardpan El Previous Application Made: Yes Oo 0 New Cons-�rluction: Yes 0 No FHA/VA: Yes ❑ No D TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) � :. _.��,��L�C30 Septi T nk: Distance from nearest well___-------Distance from foundation__-__ ./ .�----. al- __ ___ }cft e -` -_f Mteria ^iCl No.,,of compartments-------------1/------- •-2�'-- --- ---:_---Li uid.de th_------- q P 4---------- Cal pacify--•----- Disposal Field: Distance from nearest well.....Jr0---_>Distance from foundation------ _0---_ ---Distance to nearest loft line____ Number of.lines---------------'�--------------`-Length of each line----------�.O------------Width of french-------___�a�__-_------s,. Ty'pe of filter rnaterial-------4?v-,C/------Depth of filter material-__-_y -r Total length__________/_�_-___,__fi____"' Seepage __-_- x �� tance to nearest well__�'___�__"_".______Distance from foundation_____Y::______._._.Distance to nearest lot iine_____.__� ❑ Pit: Disklumber of pits=_ t ._:f_______________Lining maerial__^____________-_ ------:Size: Diameter-------------------- '_:Depth---------------------�----- ---- Cesspool: Distance from nearest well`_______________Distance from foundation---------------- _-:Lining material_____---__________-___-__._____ __ ❑ Size: Diameter--�e'-------------=------ �► . .. Depth_ Liquid Capacity = gals. ; Prey.: Distance from nearest well__-______'___________________ Distance from nearest building .f ` ---------- Distance to nearest lot - - - Remodeling and/or repairing (descrsbe):___-_---/�r- _t______c `T,� ,--__---f ��/ ---* / Q-------7 2-4--7a------- - -------------------=------------- --- y ----------------------------------------------------- - , 4 •I --------------- --- ------- •------------------- c________________ ! hereb certif that have re regd this a lication and thagt the work will be donein accordance with Y Y P PP th San-Joaquin County ordinances, S laws, rules re ulations of the San Joa uin Local Health District, fi C Y k (Signed) ` -� -- .-------- -x--- ------- - ----(Owner and/or Contractor) BY: - ----- -----`._.__--_--------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot„ o;catilon..of system in relation to wells;buildings, etc can be placed on reverse side). FOR DEPARTMEN 1 ,USS-O•NLY S” APPLICATION ACCEPTED BY" -------------------------------------------- DATE----------------------- ------------- ------- REVIEWED BY------------ - " " -----=--- "' DATE--- ------ `-�- ----------------•-------------- BU1LDlNG PERMIT ISSUED-- -------- ----'---- --- a"' " DATE-------. ----------------- ` Alterations.and/or.recommendations:__-____ -_____ -^ -------------------•--- --- - - ----- ------------------------- --- _;r----------- r - ,j G ---//� j_'__ ,C �'. / iC� °=r � '� t� e �_---- t'a-1 ------------- w ---- •-��, eca `--•-• _ - _ -------- ------------- --------------------- •---- C 1_.__ --�------ -------- FINAL INSPECTION,..BY:_: =' ------------------ _ Date-------------- SAN -------- --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-