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APPLICATION FOR SANITATION PERMIT Permit No. __•--G,7- l� 11• (Complete in Duplicate) —� Date Issued Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described, fi This application is made in compliance with County Ordinance No. 549: r i� JOB ADDRESS A D LOCATION.-A_ U C Owner's Name---- -- -------------- - - te -- --- j ...-.._.__. C----------- ----------------- Phone-_._ iAddress _-------- --------••-•- --- N fh -------•-----------•-----------•----------•- Contractor's Name-- - -- Phone- nsta lation will serve: Residence Apartment House-❑ Commercial ❑ Trailer Cour} f / 0 ❑ Motel ❑ Other ❑ Number of living units: __I---- Number of bedrooms 'T-.. Number � baths _/ Lot size Water Su I Public system �Communit system l pPY' Y Y ❑ Private ❑ Depth to Water Table ----------ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ . r Previous Application Made: Yes [] No N111, New Construction: Yes r No ❑ FHA/VA: Yes ❑ No TYPE-OF INSTALLATION AND SPECIFICATIONS: t (No septic tank;or`cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt-----------------Distance from :foundation -_-----------------Material---_--.--.--_--"-"---- " No'. of compartments-------------- -- `� .AS.ize-------------------- -------Liquid depth-------------- -----------Capacity................ Disposl F,ie ,:T Distance from nearest well_ - _Distance from foundation__ r� ,,; -- Distance to nearest lot li ►� Number of lines----- ...... -------------- -Len th of each fine---_----= -•---• Length fi-----.Width of trench-------.g+ - e�. Type of filter material 'Depth of filter material-__-.-, _ _ Total length ---_ E g - r . Seepage Pit: Distance to nearest well---_.___--____ Distant fro ou ation__!_ - ' Di arcplfo nearest lot line 5� e� Number of pits-----X-----------:Lining material !`" _ re: Diameter-------JpD---- --De tn-----7I ' p - 0 ----------------- Cesspool: Distance•from nearest iwell--- ".-_-------Distance from foundation-----_ DLinin g material----------- F1 ____--"-.-❑ Size: Diameter---------- --------------- Depth =` = Li uid Capa .- - .- ._ --------------- ----- --- ---------------------gals. r Privy: Distance from nearest,well____-.__"_----_--__"_____ ------------------Distance from nearest bul{ding _-- ' ❑ Distance to nearest lot'line--_________ - a ,,�—.�,---_---"--.--}"-_� -------- ----------- ------------ Remodeling and/or repairing (describe):- ti---__._ 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 and regulations of the San Joaquin Local Health District. (Signed)-------------------- ----•-- 4 i (Owner and/or Contractor) Y• ---- --- {Title) ----------- (Plot plan, s owing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTEDBY - -_-_----------_-_-_-"---_------------------ ------------�-- ---------------- ------ D ATE_REVIEWEDBY BUILDING PERMIT ISSUED__________ _ ------------------------------- DATE_-- -_-1 •----- .. -_ - ---j-- ------- ------------- p ,_Alterations anr recom endations:__.___- - - ------------- ---------------------- ------------ ----------- ----------- -- ` ----------- - --- -- -- - -- -- ---, - - -- f--�- tr�tt.0 ` s 3�� ------ ;f /�----- --- ` / --------------------------------------------------------- 1 -� � -_------ ---------------------------------------------------------!----- ' Date---FINAL INSPECTION BY:------ -- " SAN JOAQUIN LOCAL EALTH DISTRICT 130 South American Street 300 West Oak Street 1 132 Sycamore Street 814 north "C" Street Stockton, California Lodi, California Manteca, California Tracy, California :ES---4-21x1 Revised 1.57 F.P.CO.