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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7- V� Date Issued _____��5__� Application is hereby made to the San Joaquin Local Health District for a permit to construct and instalf the work herein described. Fhis application is made in compliance with County Ordinance.No. 549. JOBADDRESS AND ATI N----- ��---= - ------------------------------------------------------------------------------------------------------ Owner's Name-------- L ` ------.-. Phone------------------------------------ Address--------------aV---------------jj__4--- - -�. Contractor's Name ! --------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence .'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: j---- Number of bedrooms _ Number of baths J____ Lot size -_----------------- ----------- Water Supply: Public system A,_"Community system ❑ Private ❑ Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑I No V2,"New Construction: Yes &O—No ❑ FHA/VA: Yes Woo No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I r r_. Septic Tank: Distance from nearest well__` _____Distance from foundation___A®_--------Maferial_____ ___. No. of com artments_____ _ _P .___Liquid depth____ _ r-________Capacity..-?,��____-- p I �------------- Size__ � - - 1 Disposal Field: Distance from nearest well__- ----------Distance from foundation_------------------ to nearest lot line--- _______ ®� Number of lines__________�____________________ Length of each line_____ - ______________ �� I � � _� x. Width of trench/.�_-�Zi'�_______________ __ Type of filter.material___/jt Depth of filter materiaL___If_ _______Total length._----l-7---__________________--__-- Seepag Pit: Distance to nearest wel#------- '____ Distance fr f nd _ation_ ........D ;ince to nearest Io„t lime---- _. 1 Number of pits__ .___ -----------Lining material--- ------ ---------Size: Diameter--- ------- .Depth--- __ --------------- �+ Cesspool: Distance from nearest wel!--------_--------Distance from foundation-------------------.Lining material-------------------------------------- ❑ Liquid Capacity Size: Diameter--- Depth -- -------------------------------------------_ qid Ca p Y- ----------•---------------9als. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------______________-____________- ❑ Distance to nearest lot line---------------------------------------------------------------------- ---------------------------------------------------------------------- { Remodeling and/or repairing (describe)--------------- -.. -----------------------------...--------------------------------------- 1 1 ----------------- I-hereby certify that I have-prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules rd regulations of the San Joaquin Local Health District. Si ned - ----------------------------------------- ---------------------( r Contractor) By:---------------------------------------------------------- -- -------- -*- ---------------------------------------{Title)-------- ��'----------------------- (Plot plan, showing size of lot, location of s em in.relation to wells, buildings, etc., can be place on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---------------------------------------------------------------------------------------- DATE----------------------------------------.^-r REVIEWEDBY------------------------------------------------------------ ---------- ----------------------------------------- DATE------------------------------- i BUILDING PERMIT ISSUED------------------------------------ -- ------------------------------------._._ DATE----- Alterations and/or recommendations:----------------- ------ ---------------------- ----------- - ---------------- -- S---------------- ----------- ------:-� --------------------------------------------- ----------- -.��..------ I - __ -___.____-_--------------�j- `"----------------------------- -------------------Y-7--v --------- --------------------- -•------------------------- - ------- -------------------------------------------------------------------------------------------- /� // FINAL INSPECTION BY-------- -- -- - Date � r 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.