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APPLICATION FOR SANITATION PERMIT Permit No. 'Z (Complete in Duplicate) . � - Date Issued Application is h reby 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 withe ount Ordinanc . 549. JOB ADDRESS AND LOCATION/ v �ew tom=�-_--- -- -------- -`- -- Phone- =Owner's Name '-- ---- _ r/Address--------------------------------- ----------------- Phone-Contractor's Name--- Installation --J- will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/._. Numbe .bedrooms ---2�.-Uumber of baths /-___ Lot size ____._ __;t d t?___________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla oam [❑ Clay ❑ Adobe [A-, ardpan ❑ Previous Application Made: Yes ❑ I No ew'Construction: Yes o ❑ FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if blic sewer is available within 200 feet.) f "/ Septic Ta Distance from nearest well__�Distance from foundation--/10__________.Material___�C.-A?,�-/C-K________________. No. of compartments ____-_ _-_Size_ d__,__Li 'id de th____� � �__-_--Capacityr�.________ P ---i 9 p � - Disposal Id: Distance from nearest wellk�Distance from foundation_ __I------Distance to nearest lot line,-5'___�___.... Number of lines--'__--_j------------------------Length of each line_-__- Q___f__----------Width of french_ay----------------------- ' Type of filter material __r9_C}�------Depth of.filter material---/_VZ--------- otal length---__� -------------------------- Seepage Distance to nearest well__✓- ''__Distance from*foundation____/-"---.Distance to nearest lot line -__-__-_ Number of its----- _.___Linin material---Y'01G Size: Diameter-_.-_ _____-.De ____ , Cesspool: Distance from nearest well________________Distance from foundation------------------- material-------------------------------------- 171 _-._-- -------------------_________.❑ 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):---------- ------ - . -•------------------------------ ---------------------------------------------------------------------------- ----------------------------------- ------------------------------------------------------------•-------- ---------------------------------------------------------------------------------------------------------------- 1 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 r and regula •ons of the San Jo uin Local Health District. (Signed)--------------------------- - -- -- ------------------------------------------------(Owner and/or Contractor) By: (Title) -------------------- I (Plot plan, showing size f +, locati oofi f sysfem in relation to wel[s, builds ,�eZ, can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------------------- ' DATE-------;.. REVIEWEDBY ----------------------------- ------ -- ----------------------------------- DATE . }� BUILDING PERMIT ISSUED----------------------- - ------------ DATE Alterations and/or recommendations:--------- ----------------------------------------------------------------------------------------------------------------------•------------------ --------- -------------------------------------------------------------------------------------- ----------------- Fe =v -r ----- ----------- ------ ------------------------------ -------------------- • ---- ------------------ -------------- -------a ------------------------------------------------------------ ---------------------- --- -------------- ----------------- FINAL INSPECTI ----- - ------ Date = -5 -------------------------------------------- SAN ----------------- -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 R ES-9-2M Revised 1-57 F.P.CO. — fi