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APPLICATION FOR SANITATION PERMIT Permit No. Z ------�- •f�' (Complete in Duplicate) Date Issued ___:9/��--�'-- Application is hereby made to the San Joaquin Local Health+District for a permit to construct an install the work herein described. This application is made in compliance with County Ordinance No. 549 f � JOB ADDRESS AND LOCATION--- '� _ -- y s Phone Owner's Name------------- �I� .�--�r le Address-----------------l Contractor's Name__"-_____--__-_ Phone- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number` of bedroomsg?-- Number of baths __/"_ Lot size ____ - .� ----------- Number of living units: I--" - ._ P r Water Supply: Public system; Community system ❑ Private ❑ De th-to Wafter Tablets__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 26, Hardpan 0 f Previous Application Made: Yes ❑ No [' New Construction:. Yes ❑. No ( ' FHA/VA: Yes ❑ No/t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pu 'c sewer is available within 200 feet.) r ` Material- -------- -- Sep i Tank: Distance from nearest well_. Pfl�Distan e fIpm foundation___ =Size Li uid de th--- � r -------Capacity.... -lq No. of compartments___._____ _- Ir Distance from foundation--2-0 Distance to new loft lin _ '0 Dispo al Field: Distance-from nearest well. _�3,�� '�.// " "'""" �T Number of lines-------- ------ -- --Length of each line-___.7�?---- L� I Width of trench-__ 4/------------------- 'r - --- ---•-- ` 'r� Type of filter material___ U /-C-1--Depth of filter material_""-�(,h_____"F.._Total length------ ---------- cF©--__-"".Distance to nearest lot Se Number a Pit: Distance to nearest well_"__ �j-r�r_-Distance„ft~om foundation__." F Jam' �• � V' Number of its-__,C g --:----Depth-., Q- p "-___-.-__""---_Liriin material_--_-- --G.-- -:--Size:;Diameter=_ Cesspool: Distance from nearest well______________':__Distance from foundation_._._----"-__.____".Lining material_____________------- als'r ❑ Size:Diameter-----=-�=------------------------------DepthI-----------=-------------------------------------- Liquid Capacity ._._..._.__. = g 9 ----__ " - ------ti. Privy: Distance from nearest well-------------- -----Distance from nearest builcling------------------------ '---- -------------------------------- Distance-to -------- ---------------Distance to nearest lot line______________ M a. 3 Remodelin and/or rep4 airing (describe): `-------- --------------"----------------------•--------- -- 0 g / P 9 } ------ ----------•-----------•---- -----•----------- ---•-------- --- -----------------=--•------ }. ------------------------- ----- --------`-------------------------"--------------------------••---------------------------=-----------------•---------- I hereby certify that I have prepared this applic on and hat the work wili.be done in accordance with-San Joaquin County ordinances, State laws, and rules a r gula 'pns f the $ Joaquin Local Health District. .� n r and/or Contractor) _ --- ---- ---- -- (Signed) -•-- - ------- - --- ----- - --------------- By:-------------------------------------- ---------------------------- (Plot ------ (Plot plan, showing size of lot, location of system in relation to wells, buildin s, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY DATE.------ =--------- APPLICATION ACCEPTED BY DATE -- r-"'---� -- ----.•------ REVIEWED BY----------------•--------------------------:-- ---------- ------- -- -- --- ----------=--------- - BUILDINGPERMIT ISSUED--------------•------- ------- --- �-------------- -- - .-------------. DATE------------------------------------------------ •- ----- ----- ----- Alterations and/or.recommendations,------------------- -------------------- - ----------------- ---- -- "" __------ ----- " *---- - _7-------------------------- ------- ------ --f ------------------------------------- - - - ---------- D t -----, _-F1NAL INSPECTION BY_--- :. _._-�--- " - � , SAN JOA IN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street E30 South American Street - 'Free California Stockton, California Lodi, California Manteca, California y. ES-9-2M , Revised .1.57 FYCO-