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APPLICATION FOR SANITATION PERMIT Permit No. ,�, (Complete in Duplicate) 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. 544. JOB ADDRESS AND LOCATION--------- ----------- = Zo-- Owner's Name------- -----ce --------•------------ --------- ---------------------------------------- - Phone. --------------------- Address - ,e ------------------------------•----------------------------------•------•--•-----------------•. - -�--"G- ------------- - - ------------L------------------- --- .. Contractor's Name_________ --� g Phone- �(_ .... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel q Other ❑ ,{ Number of baths _I--_ Lot size _________7 ----X---- 10-0•"" ---•------- Number of living units: __f--_ Number of bedrooms .__ __. , Water Supply: Public system Commuriity system El Private ❑ Depth to Water Table ft. j Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Clay Loam ❑ Clay F1 Hardpan Hardpan.11 ❑ Previous Application Made: Yes El No W New Construction: Yes ❑ NoY FHA/VA: Yes E] Noo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 244 feet.] U Liquid depth Ca acit 3 pf Distance from nearest well----------------- from foundation_______________ Material-_____._--__._. _ p Y f No. of compartments-------------"------------Size----------------- -- /�- ` Distance to nearest lot line_�4------- '?r p Dvs F' Id: Distance from nearest, well _ ._��_.Distance from foundation____ _ Number of lines____________ _ _____Length of each line__-___,��-_----r------Width of french__�.gr.-�__:__ --- ------..------ � ----Depth of filter material_____-l�__- --f-'Total length 1� lined Type of filter maferial_____ G��- p SSI '. �.-------- Se e Pit: Distance to nearest ell__ ---Distance from foundation__-. '.Distance Number of pits------- ----------Lininq material----- C.�Size: Diameter---r -- -------.Depth--.- -';------------- 1 -------------- Cesspool: Distance from nearest well_________________Distance from foundation._. _._______..____.l iing matperialy"_ -_-- gals. ii ---------- Depth--=---== --------------Liquid Capacity---•-------------- ❑ Size: Diameter______._.--____----_-_ -; } { Privy: Distance from nearest well------------------------------------------------- from nearest building__________.__________________--_.______.. -----f------- Distance to nearest lot e----- ---------- ------- --------------------- ------ -----------�- m Remodeling andrepairing (describe):__..__ ----------------------------------------------------------------------- -------------- ----------------------- ------ --------------------- ------------------------------------------------------ I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1.44q, and rules regulations.of the San Joaquin Local Health District. - ----------- Owner ancVor ---------------- Contractor) (Signed} ------------ ---- ------ in-- --etc. can be on reverse side ] (Piot plan, showing size of lot, location of system m relation to Ils, buildings,, P i FOR DEPARTMENT USE ONLY DATE---------------- -- -------- -------- - - APPLICATION ACCEPTED BY--------------------- ------- ------------------------ ---------------------- --------------- DATE-----------� y REVIEWEDBY--------------------------------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------- ---------- ---------- -------------------------- -------------------------•--- DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------_------------ ------ --------------------------------------- ----------------------------•---------- ---- ._____--_c________________________________________________ ___ ----------_-------------------------- ___________________ ________ ------------------------------------- _____ FINAL INSPECTION' BY----------- ------ --- -- - ---------------------- Date __________'1___--._____..___ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y, ES-9-2M Revised 3.57 F.P.CO. 1