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' APPLICATION FOR SANITATION PERMIT Permit No 1�_�a__r-�_._ (Complete in Duplicate) p ) . 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. 549, JOB ADDRESS AND LOCAT N -/ ~`------ - ---- ,2- ---- r -------------------------------------•--------------- ------- Owner's Name------------ r'C_Sr' --- - ---------------------- -- -------------------------------- --------.,- -- ------ Phone.----------------------- Address ------- %V- ------- - ,.--- -----------n---- -------------------- -------_------------------------------ --------- ------------••------------------------ v Contractor's Name v - ——--------- -------------------- ---------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ®0"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms . Number of baths ___-/__ Lot size __ __ _ -,�/ --------------------------- Water ________________________Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table e ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2'-_'Hardpan ❑ Previous Application Made: Yes ❑ No MO*�New Construction: Yes Zj-"N_o ❑ FHA/VA: Yes ❑ No ®-'. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted, if public sewer is available`within 200 feet.) Septic Tank: Distance from nearest well___' ��____Distance from foundation---1_! ----------Materiai___ _w___________. - . No, of compartments,.__ ---------------- .___ _ Liquid depth------6 (y s Capacity..._ Disposal Field: Distance from nearest well--- -- -----_Distance from foundation.,___1e---___.Distance to nearest lot line___ 1--,. � ®� Number of lines_____ _= __.._ Length of each lin_Q__-____.: ?/'_____________Width of trench--�--,-•—*2. ---------------- Type ________.__._ Type of filter material_°..________Depth of filter material__,t� '_ --------Total length____---{ /-_____________________ �� Seepage it: Distance to nearest well------- from foFV I dation_____IP_�._..Distance to nearest lot line__- - -_ Number of pits------/-------------Lining material_ .Size: Diameter__ _P�-------Depth------A.e.!-------------- Cesspool: ____________Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________________ ❑ Slze: Dia 1 _Liquid Capacity ` meter--------------------------------------Depth_-° =-____, - = - q p Y gals. !' Privy: Distance from nearest well ____--.--------------------------------__...._Distance from nearest building_-___.________________________------_-.-_- ❑ Distance to nearest lot iine--------------------------------------------- - ----------------------------------------------•---------------------------------------- r i Remodeling and/or repairing (describe): ti�.- - - `' ` ------------------------------------------•------------------------------------ --------------------- -------------------------------------•----------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ - • 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 and regulations o the San Joaquin Local Health District. I (Signed) 41 -- By:----------------------------------------------------------- ----------------------------- ------ J-------------------------- (Plot plan, showing size of lot, location of s em in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------- ----------------------------------------- DATE----------------------- ✓ / REVIEWEDBY-------------------------------------------------------------------- - - -- - -- ------------------------------------------ DATE------------- -- ---- BUILDING --BUILDING PERMIT ISSUED--.--.--------------------------------- - --------- DATE------------- --- --- ----- ---- ---------------------------- --------------------------- Alterationsand/or recommendations:----------------------- -- ---- - - - ---- ------------------------------------------------------------------------------ --------------------------- - - -•---•---•------------------------------------------------------- Q. -�------- ------------- ------= --- ---------------- - ---- FINAL INSPECTION BY:------ _____ Date------------�� f7✓-5� SAN JOAQUIN LO L HEALTH DISTRICT t, 130 South American Street 300 West Oak Street r 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revises 1.57 F.P,CO.