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& . �f 7 APPLICATION FOR SANITATION PERMIT Permit No. ___��_I__'Y_.L-.___ (Complete in Duplicate) 1/4 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. eD JOB ADDRESS AND OCATION_ 3__�P� / __� ------------ -I-.0CA/ ------ ------------------------- Owner's Name ------------•-- -------- - -------------------------------------------- Phone -------- - -------- --------- Address__ r--_ Contractor's Name---- ----------- -- v .If�Q_/_..--------------------------------------------------------------•--- Phone----•---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms --7--'Number of baths _-/- Lot size---`?J41_--- ----------------- Water _ -----------------Water Supply: Public system ❑ Community system ❑ Private E-16epth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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.) k:, Distance from nearest well_________________Distance from foundation--------------------Material______________--_---__________..._____________.. No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- isposal Fie Distance from nearest well---- �_ ---Distance from foundation_3-4_____------Distance to nearest lot line ------- -------- Number of lines---------�_______j_J� ---Length of each line__ _0.0__ _____________Width of trench____ Type of filter material- ---Depth of filter material--- &-___________Total length----/A__4_-________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.______________ ❑ Number of pits----------------------------Lining material-----------------------Size: Diameter----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------- Lining material__.-___-___.____.________--_________- ❑ Size: Diameter------------ --------------Depth-------------------------- --- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-________________-______-____.____._. ❑ Distance to nearest lot line — Remodelingand/or repairing (describe):--------- ----------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------w----------------------------------I---------------------------------------- -------------------------------------------------------------------------------------- I hereby ca 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, and rules and regulations of the San Joaquin Local Health District. (Signed).----- --------•----- (Owner and/or Contractor By:---------------------------- (Title) +d/► (Plot plan, showing size of lot, location of sysfe relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------------- -- - -------- ---------------------------------------------------- DATE----------------- s :yam -- •�---------------------- --- REVIEWEDBY-------------------------------- ------------ ------ --- -------------------------------------------------- DATE------------- BUILDING PERMIT ISSUED -- ------- ---- - DATE Alterations and/or recommendations----------- ------------- --------------------------------------------------------------•------------------ ---------------- FINAL INSPECTION BY:.-- �-174------------------- Date__� ---'0 -- ------ ---------------------------------------- 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---9-2M , Revised 1-57 F-P.00.