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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued 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 Ordinance No. 549. JOB ADDRESS AND" LOCATION------- ----------------------------- Owner's Name ------------ In,15-1 CIA1QST------- -- 19 4�1 -- — ---------------------------------- ----- ------------------- ------------------ Phonel4w --------------------------- Address ------------ /_9 - ffo_-------- -------------- ---------------- Contractor's Name___:�� -------Phoned Installation will serve: Residence E] Apartment House El Commercial E] Trailer Court [-] Motel [I Other F1 Number of living units: J--- Number of bedrooms j---- Number of baths I--- Lot size Water Supply: Public system []. Community system 'E] PrivateX Depth to Wafer Table 'Vo ft. Character of soil to a depth of 3 feet: Sand [I Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes [:] No 9 New Construction: Yes E] No E] FHA/VA: Yes E] No,E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Septi £ Distance from nearest well-------------- Distance from foundation__-____________.--- Material______________--__-_____-_____________-_-______- No. aterial------------------------------------------------- No. of compartments -------------------------- Size---- ---------------------------- Liquid depth -------------------------Capacity------------ ----------- s Field. Distance from nearest well_.,�T ------- Distance from founclation-__/0 ---- f ----- Distance to nearest lot line____.;�. Number of lines --------- Length of each line ----- ro -------- Width of french ------- *t� *7> ------------- / ------ ------------- Type of filter material k_4Ae_____Depfh of filter maf"erial ------ /4 ---------- Total length___--- --------------------------- I oe- Distance to nearest well ------ - --- --------- Distance from foundation ------------- ... -.,Distance to nearest lot line__-_____________ Number of pits -------------- ------- Lin�ng ma�ferial ----------------------- Size: Diameter----•-------- --------- Depfk__= ------------- ------------------ C .. Poo Distance from nearest well_________________ Distance from foOndation -------------------- Lining material_____-___________-- ------------------ El Size. Diameter------------------------- ------------ Depth ----------------------------- ------------- --------- Liquid Capacity-... --- --------------------gals. Privy: Distance from nearest well --------------------------- --------------------- Distance from nearest building --------------------------------------•- ❑ Distance to nearest lot line Remodeling and/or repairing (describe): ------------ � A&Z� ---------- ------ - -------------------- t; -------- --- — ----------------- V ---------------------------------------------------------------------- -------------------------------------------------------------------- ----------- ------------ __ 7- �__ --------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - L - - - - - - - - - - - - - - - - - - - - - - ---------- I ---------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe7lws, and rules gad -regulations of the San Joaquin Local Health District. ------- -- -- - - -------- -------------- (Owner and/or Contractor) (Signed ---------- ------ ,, By: ---------------------------------------------- --------- --- ---- ------------ ------------------ (Plot plan, showing size of lot, location of sygf5min relation to wells, b ings, etc., can be placed on reverse side). R _, DEPART USE ONLY APPLICATION ACCEPTED BY------- --- ----------------- ------- ---- ----------------------------------------------------- DATE REVIEWEDBY ------------------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------- --------------------------------------- DATE------------------ - ------------------- Alterations ATE------------------Alterations and/or recommendations---------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------------------------------------------------------- ------------------- ------------------------------------------------------- ------------------- ---------- I ------------------------------------------------------------------- I -------------------------------- ----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- ------------------ ------------------ ------- - 1- --------------------- I ------------------------------------------------------------- --------------- --------- FINAL INSPECTION BY______________ --------- --- Date --------- ww� __ �___ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Sfock+on, California Lodi, California Manteca, California ES -9-2M Revises 1.57 F,P.CO. 814 North "C" Street Tracy, California a