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APPLICATION FOR SANITATION PERMIT Permit No. ---.._P..-U.!�. _ (Complete in Duplicate) s 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 L CATION.- '� �a`, --- --------- ------ ------- - l Owne`r's Name- _ 1� �"'�' ----------------- Phone---- =' Address---'-- Contractor's Name + e ------------------------ ---------•------------------------------- - Phone-------•-•------=--------•-------.. Installation will serve: }Residence ® Apartment House ❑ Commercial ❑ Trailer Court f 1 ❑yot'e'I ' _ -., her ❑_____________________ Number of living units: __--._. Number of bedrooms '-A----- Number of baths _-�----- Lot size ----_ Water Supply: Public system ❑ Comrimun'ity system ❑ Private ® Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe W Hardpan ❑ E Previous Application Made: Yes ❑ No X New Construction: Yes K No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) J Septic Tank: Distance from nearest well--%7e__"__Distance from foundation-YR-----___ M t _- er .t No. of compartments----�---- ial ------------Size_g 3 ----- "�_ .-- Liquid depth - --------------------Ca Capacity Disposal Field: Distance from nearest well---6.�!--- foundation-A& p y - - _.Distance from -----------Distance to nearest lot line---A-5_-_____ � Number of lines------.1__---- Length of each line_----_ O �-�-- '- �-- 9 �------ ---------------Width of french---�•��-------- ------------ Type of filter materiDepth�of.frlter material_-dry---______•__Total length---_ Q�- ---•------------•------------ Seepage Pit; Distance to nearest well--,/ -------_____Distance from f undation__f/P_--_------,Distance to nearest lot line-_----- Number of pits._-l----------------Lining material/ �-___-Size: Diameter__ Cesspool: Distance from nearest well--------------- ce--Distanfrom foundation-------------------- 1 .Lining material------------------- Privy: Distance from nearest well--- Depth - Liquid Capacity -------------gals. Size: Diameter---------------------- --- Priv i ! + ---___Distance from nearest buildin ❑ Distance to nearest lot line- ------------------------------ ------------- Remodeling and/or repairing (describe): ----------------------------------- _ - +.r ----------------------- ---•- --------------- ------ --------- -� 7..� ordinances, State laws, and rules end regulations as Ii the San JDistrict.---ac -r ----ce ------ with --------- -- --.- - -- - - - -------- - ------ ----- ----- ------ ---- -- --- --- --herebycertifythat I have prepared this a litation and that the work will be done in accordance with San Joaquin County 9 Joaquin Local Health V (Signed)---7�l----!----- �-<7 - (Owner and/or Contractor) By-----------------•-------------•--------------•-------------------------------------------------- ----------------------------.----(Title)-------------------------- - (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 APPLICATION ACCEPTED BY-- -. - DATE___-4 - _ , VIEWEDBY 7------------------1-1----------------•---------•----------- ------------------ ----------- -------•---- ----------------------------------- ------------ --- BATE----- --•------- ----=--------- - BUILDING PERMIT ISSUED-------------------------------------------------------- ------------------------------- ------ DATE Alterations and/or - s:------- �-*------------ 1 " ---- ov -------- - --------------- ---- ---------- /J�//�f q�sryy�y ------- ------------- 1 FINAL INSPECTION BY: _ ----------------------------------- ------ Date - 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 E5-4-2M . Revised 1-57 F.P.CO. .to