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��. APPLICATION FOR SANITATION PERMIT Permit No. ...1 ..�'z— �` U (Complete in Duplicate) 3 / This Permit Expires 1 Year From Date Issued 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 Or in ce No. /4 . JOB ADDRESS AN/D�LOCATI N - ----• Owner's Name ------- -------------- -----------•----------- ------ ------------------------------------------ Phone----------------------•---------•--- Address------------ f E3 Contractor's Name------------------ n -•--- ------------------------- ---------------------•--------------•-------- Phone =_ Installation will serve: Residence [E_ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__Number of bedrooms _4 Number of baths Lot size _______•5.' 17 _---------------•---------_ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table W ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �Iardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [t4-""FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti Distance from nearest well_________________Distance from foundation____-____________.Material-___---_______-_________----._________- No. of compartments---- --------------------Size_-------------------------------Liquid depth------------------------- Capacity--- �-� ' ' Disposal Id: Distance from nearest wellDistance from foundation-.,�Q______-___Distance to nearest lot line__ ______ Number of.lines--------- __---- Length of each line__._.3-Q----------------Width of french_---��_ .____---_____--_ ----------- Type of filter material_ _ _-_�_---Depth of filter material--__--1-$__`_'-------Total length-----------------.3_IP_______________ � r �. r Seepage Pit: Distance to nearest well`7Lx� ---Distanm undation____,/!�____.___.Dista`Fe to nearest lot line------- - Number of pits-----�-------------Lining material_- f -----Size: Diameter--- - Cesspool: Distance from nearest well-----------------Distance from foundation___--- ----.Lining material------------------------------------- (A ❑ Size: Marneter--------------------------------------De th----------------------------------------------------Liquid Capacity p q ---------- -----------------gals. Privy: Distance from nearest well ______---------------------------------------__Distance from nearest building----------_------____________________-.. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)----------------------------------------------------.------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------•-------- ----------------------•-------------------------------------•------------------•----•------------------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, a rules and egula ' ns of the San Joaquin Local Health District, (Signed)---------- ,- g-G K --- --- caner and/or Contractor) BY ---------------(Title)---------�� -------------------- - - - --------------- (Piot plan, showing size of lot, location of system in relation to we b (dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ---------- ----- ------- ---------------------------------------- DATE REVIEWED BY------------------------------------- -- --- -- ------------------- DATE----- eE�� BUILDINGPERMIT ISSUED----------•--------------------------------------------•-•------------------------------------------- DATE-------------••---------------------- Alterations and/or reco mendations-------------•----.-- ---_--_-- ------------------ ----- - -- - --- - = --:.�--- = ----------------a----- ------------------------------- ----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ FINAL INSPECTION BY:---.o_- -0- / Date -`31-- �C/ 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 ES-92M Revised B-'S9 F.P.Co.