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APPLICATION FOR SANITATION PERMIT Permit No. .... ._.7-_ (Complete in Duplicate)Zoe Date Issued Appl• ,ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a(plication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_- 6j-7---- Owner's Name------�a—rt�--- G�t�------•-----••------------•-----••---------•--------------------------------------- --------------- Phone---------------- •--------------- Address -------------- - - ------------------ -------------------------------------------- Contractor's Name--------------- Phone----------------------------------- --- - Installation will serve: Residence [,Apartment House ❑ Commercial ❑ Trailer Court E] Motel C1Other E]Number of living units: J___ Number of bedroom's _fir qq _ Number of baths __l__ Lot size __ � �------------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table =f tt• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rg-17ardpan ❑ Previous Application Made: Yes ❑ No UR' New Construction: Yes ❑ No [9--__FHA/VA: Yes ❑ No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sep is Tank: Distance from nearest well_________________Distance from foundation--------------------Material ______._______-_______________-.____-.________. No. of compartments--------------------------Size---------------------------•----Liquid depth--------------------------Capacity---------------------- Disp sa Field: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line______-__________ ' Number of lines--------------------_------.-------Length of eachline------------------------------Width of french.---------------------------------- Type of filter material_________________________Depth of filter material-----------------------Total length_---_________________-_-____________-_--- See ge Pit: istance to nearest well___ ` _ p } '__Qistance from f ndation__��_________..Distance to nearest lot line____✓?_--__.__� i �-.Size: Diameter ". Number of pits - Lining material �� Depth - o Cesspo I: Distance from nearest well_________________Distance from foundation-------------------.Lining material__-.-___._.___._-_-._-_---._________- C , ❑ Size: Diameter--------------------------------------Depth-------------------------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------------._-Distance from nearest building------------------------------------------ F71Distance to nearest lot lire-------------------------------- --------------------------------------------------------------------------------------------------------- Remod lin and/ojrepai6n�g [ escri e) ------- -- ------------------t------------------------------------� '� &--- -----.P`s � ? ��~�"a, �.�, ('_��` +f ..� r ' - -- 'ttt = =° --------------------• --------------------------•----------= ,--•-----------t- - i I 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 rules a d regulations o the San Joaquin Local Health District. (Signed) ---- ---- --- - ( l�4or Contractor) By:------------------------------------------------- - ------- --------- - --------------------------------- -�------------------- (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------------------------------------------- ---------------------------------------- DATE'S --------------------------------------------------- REVIEWED BY------------------------------ - QATE BUILDING PERMIT ISSUED...- -- - ---------------------------------------------------------- DATE---------�------- Alterations and/or recommendations:---------------------------------------------------------------------- --------------------------------- ----------------------- --------------------------------------- -------•----- ------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------•------------- -� -- ---- ---------- ----------------- ---------------------- ------------------------------------- --------------------------- -- 2-- ---- ---- -- ---------------------- ------------------------- -------------------------------- •------------------------ Y_ FINAL INSPECTION BY Date-- ------------ SAN r SAN JOAQUIN LOCAL HEALTH DISTRI 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revisea 1-57 F.P,CO.