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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to 4const�ructinstall the work herein described. This application is made in compliance with o ty Ordinance No. 49. JOB ADDRESS AN ATION_ __ . Owners Name.---- - - --- �t------------- - -- --- Phone .. .. ,. __. ; -- Addrens-L.......... Contractor's Name -� - -- --- -------------- -- Phon Installation will serve: Residence Apartment House ❑ Commercial ❑ �T�aile Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms s_ 5:12 Number of baths _ _::.. Lot size __ __�__. ` _Cf-____._.._ Water Supply: , Public syste�f3fcef: S;ncl [ Community,system.❑;,Private:❑,,,Depth'to Water Table,`. ft. Character of soil to a depth Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yeas ❑ No 94--,"-New Construction: Yes E] Noj5_—FHA/VA: Yes ❑ No Eg----. TYPE OF INSTALLATION AND SPECIFICATIONS:', � (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se i kill Distance from nearest well_________________Distance from foundation_X-- --Material----------------------------.____-_-.-________--- No. of com artments_______________________ __Size____________________$ Li uid depth-------------------------.Caacit Disposal Fi d: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines-----------------------------------Length.of each line------------------------------Width of french—------------------------------- Type of filfer material------------------------- of filter material-----------------------Total length---------------------.__________________ Seepage Distance to nearest well _ _Dista e fro f dation_! __..-. _. st cel nearest to line ___-.._ J Number of pits_..._____.______-Lining materia__ _ ize: 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-----•-----__._ --- - ____-__-- - -----� Remodeling and/or repairing (describe):_. _'__--------. •` " sf . ------------------------------- -. ------------------------------ ------------------------------ -------------------------------------------------- I hereby certify that I have prepared.this'application and that the work will be done}in accordance with San Joaquin County ordinance;, State s, nd rules and re9plaflons of the San Joaquin Local Health District.' _ _ [Signed} t` c + ` 4' ,(O ner and/or Contractor) F By:-------------------------------------------------- �- ------ --- -- [Title)--. -------------------------------------------- (Plot plan, showing size of lot, locati of system in.relation towelluildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' ------ DATE--- APPLICATION ACCEPTED BY---- - --- ----- iwo -------------------------------- REVIEWEDBY-------------------------------------------------------- ----------------------------------------- --------------------------- DATE---------N------------------------------------•--------•-- BUILDING . \ - ----------------------------- ----•-------------------------------'--------------- ATE--------- ---`"` ----------------------------------- Alterations --•-------------------------••---- Alterat ons and/or TrecommDendations•------------- - --- -- ------- ---------------------------------------7---------------•--- - --- ..------------------------- --------•--•-------••---•-------------------- -------------� '__._--� --- ' --- 'L---` `- ------------- ..... --------------------------- C' --•------------------------------- --------------------------- -----------------------------------_-------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--- = - Date-= `r y f --------------------- 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-7-2M . Revised 1-57 F.P.CO.