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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Du licate{ P P ) / �1 Date Issued ------`5--7 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 OPOnance //N�o. 549. JOB ADDRESS A LOCATION A E f4%lAlf� OwnersName----�------;4- -- -----•------��iL1y------•-•--------•---- ---- -------- ------- - ------------------ - - -- -- Address - ------- --- ---------------------------•---- ------------------------------------------------------------------- Contractor's Name-------- �9'----- --- --- ------------ ------------------------------------------ Phone----------- - --- - •-----------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: Number of bedrooms 13___ Number of baths _ Lot size Water SuPPIY� Publics stem _� ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: SandEj Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2 /Hardpan.❑ rr Previous Application Made: Yes ❑ No New Construction: Yes [�No ❑ FHA/VA:`Yes [�No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public I sewer is available within 200 feet.) y �" q Q P - Ca aci ,. Septic Tank: Distance from nearest well__ Distance fro foundption-----1______ ._-_Material-___ p _ No. of compartments_ ` �� -.___Id depth____ h Size Dispos I Field: Distance from nearest well__ ______Diisytance fro o tion____1�________.Distance to nearest lot line__ _____Or [; Number of lines_________ _ _____ ______Length of each_ /_�O.Width of trench._ ____ __ Type of filter material__.,_Depth of filter material----- ---------Total length-_—:15 ------ Seepage Pit:Pit: Distance to*,nearest well--------------------- from foundation--------------------Distance to nearest lot line_________________ Number of pits----------------------Lining materia'I-----------------------Size: Diameter------------------------Deptn--------------------------------- Cesspoo#: Distance from nearest well-------------_---Distance from foundation------------------ Lining material ______________________-_____________- (� ❑ Size: Diamefer---------------------------------------Depth--------------------- -----------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_____________________ _________ __-----------.-Distance from nearest building_________________________________._______ ❑ Distance to nearest lot line---------------------L-------- -------------------------------------- Remodeling and/or repairing {describe): .- ------------------------------------------------------------------- ---- ------------• � ---------------------------- ---- ----- ------------- `'� --------------- �j �� -------------------- ----------------------------- ! hereby certify that I have T' pared tis application and t f the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) Contractor) or BY- -- •--- - ---� {Ti#le)_ ............. (Plot plan, showing size of lot, location of s m in elation to we] , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------ - -----= ===== _— DATE REVIEWED BY s- ----------------------------------- --------- DATE--------- .-- BUILDING PERMIT ISSUED----------------------------- --- _-- -------------- DATE 'S---- ----- -------------------------------------------------- -------------------------------------------- Alterations and/o recom endations__________ ______t.___.__ - ------------ - - -- - ..E/ ------ --------------- �►- -� -------------------------------------------------- ----------------------- ----------------------- --- - ------------------ I FINAL WSPECTIO Date----------- '�--- - - _-_-- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Sao West oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi; California Manteca, California Tracy, California ES-7-2M , Revised 1.57 F.P'co.