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(A APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3 f Date Issued / S 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. 49. JOB ADDRESS AND YPCATION f- --I�L_ t Owner's Name------ - � -- rv"44--7------------------------- - -------------- ------------------------------------------ Phone------------------------------------ Address ... ' -----------------`------------------- Contractor's Name -------- ---- -------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ��partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms _ ___ Number-of baths/4- Lot size - Ce - ------------------------------ Water Supply: Public system �,= Community system El Private �epth to Water Table ___t 50 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8"THardpan ❑ Previous Application Made: Yes ❑ No g�O�New Construction: Yes ❑ No FHA/VA: Yes Z�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S do T l�: Distance from nearest well_1�'_Distance from foundation_-------------_---Material__________-_-------__-..___________-.--_________- No. of compartments-----------q----�-----------Size-----•----------------------i__Liquid depth--------------------------Capacity------ -----�---- Disposa Fi d: ;stance from nearest well-70P-------Distance from foundatio,,n�j----&�.._-.Distance to nearest lot line_A.�______ ,Number of lines___-__�---------------------Length of each line-------$"02'__ _ .__.Width of french.......a_44 of filter material________ ---- -------Depth of filter material-_- _.Total length_____j�e-___ ___________--__ \y See a Pit: r Distance to nearest well_. 9�__ ___Distance f m f ndation---11 `r.D' e to nearest lot Number of its----------------------Linin" maferial=�� / P 9 size: Diameter Depth �± --------------------- Cesspool: ---------------- G1 Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material_____--____--____.________--------- ` ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line.-.-- ------------------ --------- -- ------- Remodeling and/or repairing (describe): -- ----��'----•-------------------------------------------------------- _ i 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 ules and regulat- ns of the San Joaquin Local Health District. (Signed) ` --{------------------------- r Contractor) - BY: ----l------------------- --(Title]------ ----�. (Plot plan, showing size of lot, location o ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---770R,2--------------------------------------------------------------------------- DATE REVIEWEDBY------------------------------------------------------------ ---------------------------------------------------------- ----- DATE-----------•---------------- ----------------------------- BUILDINGPERMIT ISSUED---------------•-------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------- --- 1 ---------------------------------------------PIT I?�t'�H a �,I�A �" � �----------------------- -- ------------------- __ -------- - --------- -- ----------------------------------------------------------------------- ----------- ------------------ --�� F�- � -- ---- ----- -- 1C ----------------------------------------------------------- FINAL INSPEC BY:--- ----u ---- --- -- Date-------------- - — ------------------------------------ SAN ------------------------ --SAN JOAQUIN LOCAL HEALTH`DISTRICT l 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f ES-9-2M , Revised 1.57 FRCO. I