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,� l✓'�" f ---- APPLICATION FOR SANITATION PERMIT Permit No. -_ _ _. _ (Complete in Duplicate) d� Date Issued � l 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 ANLOCATIO 39 �� Owner's Name-------- - ------ ------------- 1� - Phone_'61_-#_Q__Z, Address 3� Cr Contractor's Name -------- ---- �N ----------- �"� ---------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _.-_ Number of bedrooms • '; // _ _- -____ Number of baths __ ____ Lot size _______I -a�� - Water Supply: Public s ss m Communit system � � T -` PPY Y � y y ❑ Private ❑ Depth to Water Table ._______ ft. Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan r] + Previous Application Made: Yes ❑Y No x New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) R 1 Septic T k: Distance from nearest stance from foundation-------------------Material------------------.------._...------ p No. of com artments- well----`------ -----Size----------------------------=--Liquid depth--------- - Capacity p _ Disposa field: Distance from nearest well___? !____._Distance from foundatiori___ r / M_., 10----_._.__.Distance to nearest lot line.__- Number of lines_f______1-_-_ __ Length,of eacFi'line ` r! _, '-----F --------Width of trench..at/._ _- Type of filter materia ___ Depth of filter material___._JS------------Total length___ KRev-- 61- Distance to nearest"well___--_.__•_________-Distance from foundahion-------------------.Distance to nearest l lir �_.�l 1100' � Number U) 1I Jof pits...--•- ------------Lining material_ ..Size: Diameter--------- -----------Depth------ - ------------ Cesspool: Distance from nearest well.......... _______Distance from foundation___________ ______Lining material__-___._.-_________.________-_______ El Size: Diameter, -------------------------------Depth-----T--------- = ----------------------------Liuid Capacity ----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-------------------------------------- ❑ _-Distance to nearest lot line-------------------------------------- . ----------------------------------------------- Remodeling and repairing (describe)_---------------------- -------------------------------------- -----------••--------•-------------- ------- ----- ' r ------------------------ :r: i ----------- ---------------------------------- -----------='-----------T- ---------- 1 --------------------•------------------•-----------------------------------•--------•--•----`—'------------------------------------------------- = I hereby certify that I have prepared this application and'that Ae'.rvork will�be done in accordance with San Joaquin County ordinances, State laws, an ules and regulations of the San Joaquin Local Health District. (Signed)------- -------------------------------- (Owner and/or Contractor) - BY= ----------------- ion of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED , - -----------.-- --------- DATE ----- D-- ----- --------- - - BREV - IEWED BY-------------------------------------- --- ----- DATE----- -- -- -- --------- ------------------------------ UILDING PERMIT ISSUED--------------- - -- ------------- ----- DATE Alterations and/or recommendations:______.._____ y: -------- --------------------------------------------------------------------------------- ---------------- ' F s, ------------------------••-------------- ----------------- --------------------=-------------------------- ---- ---------- ---- --- , . -_--------: ---------- -- - ----------------------------------------- ----------------- -- --- ------- 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--9-2M - Revised 1.57 F.P.CO.