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APPLICATION FOR SANITATION PERMIT Permit No. ._. ' .__. (Complete in Duplicate) s�y� Date Issued __.._ ..--••- .- - Application is hereby made to the San Joaquin Local Health District for a permit to co and i all work hereeja0e ribe This application is made i com Tian with Count Ordinanc No. 549 0 /0 R 1 57 JOS ADDRESS LO TIO _ _ .- - -=----- --- ------ --------------------- --- --------------------------- Owner's Name ---- -- --- - - - ------------------------------------- - --- Phone------------------------------------ Address----- ---------- - •- ••-•------- -------------- -- •• -•-- ----- -------------------- ---- -----------•--' ----------`----------•---------------------------.__.__._....--------•-•- I' ContractorsName--- --•--= ---•-------•• ---- -- - --- ;---------------------------=------------------ ----��-�-------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial 7❑ Trailer Court 'E] M el ❑I Othej ❑ j _ , g I - r Number of living units. __�___ umber of bedrooms __h4_ Number c; baths _L_ _. Lot size -6-0-'X-- ----- 1A00 j Supply: Public system [ Cammun'ity system ❑ -'Private ❑'.-Depfh to_Water Teble'7tt: 'ft^ Character of soil to a depth of 3 fee+: Sand Gravel ❑ .Sandy Loam Clay Loam ❑ Clay E] dob Ae r,-Hardpan ❑ Previous Application Made: Yes E] N0 New Construction: Yes No ❑, aFHA/VA; Y s ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank'or`cesspool permitted 'if nubll'c s war is available wi+hin.200 fee } a. " Septic ank: Distance from nearest well_- --IA_ _ _ isfa fro fo'u}4ion!-f _ teri I_ '_______________________ _ [ No. of compartments---_:-- _ ,._.Liquid depth ---•__-w j----_ Capacity. _ _ e Dispos Field: Distance from nearest `well__- estance from fo ndafioi �,, istance to nearest lot ine__ d?. � Number of lines__________ ______ ength of each line___-� ji,-7_.Widfh oftrench _ ___eiType of filter maters of filter material_______ __--_:_Total length__ ___ __ -------------- Seepage ___.__-__ Seepage Pit: Distance to nearest well_':__--_-----_--'°:'_Disfance from foundation................:...Distance to nearest lot line__ __________- ❑ Number of pits-------__'_"_."_-----Lining material_________________ ____Size: Diameter---------__.__.---------Depth Cesspool: Distance from nearest^well_________________Distance from foundation--------------------Lining material__.-__._-___..___,.".__________.____. - -- Si'e: Diameter-_ _Depth - - ---------- -i-Li Liquid Capacity ---_- '---------------------Distance from nearest building."----------___- -- - gals. , ----------- Privy: Distance_#rom nearest well- ----------- --- --- 9 =•----•---------------'---------- ❑ Distance +o-nearest lot-line------- ------""="--- -- - _-- _ - _:. _ ._ ., --- , - . . Remodel g /or r pairing,{ seri _________________` - ' ----------------------------- --_ - :-y-_--------t --------- ------ ----------- --------------- ------------ - ----------------------------------- - •-•--------- ---------- --------- -------- _ - d Joaquin Local Heal be done in accord-- ------------- -- -- -- ordinances,State certify s, and rules erndpare this application the San q ante with San-Joaquin County ------------- -------------------------------------------------------------------- --------------------- At d -that-the work will Health District. T (Sig nedBy:--.-. - -15' ^_ T' ,'------------�-- {Owner and/or Contractor ------------- Y ----------------•;---------- •= -•-- ------------------------------- ' ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . ( :00 APPLICATION ACCEPTED B _ ------ -------- BATE ____-- `-,--------____-- ----- REVIEWED BY-------------------------- DATE BUILDING ons and/orPERMIT r ISSUED --dations: - - — DATE 4 FINAL INSPECTION BY:----- &t4ll, ----- ---- ----- - ---------------------------------- LOCAL HE DISTRICT y SAN JOAQUIN 134 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f � R�1J E5---9-2M Revises 1-57 F.P,CO. "+��