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APPLICATION FOR SANITATION PERMIT Permit No. Com lete in Duplicate) 3 ( P 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 O rdir� N � -.----�74g JOB ADDRESSAND LOCATION_ / __..- � � Owner's Name---------� ---------------------------------------- ---------------------------{-�-----_---------�---- Phone--------------------- •----------- Address ---------- ---------------------------------------------------------------------------------- Contractor's Name____ /1 Phone___________________________________ Installation will serve: Residence 09— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/.-- Number of bedrooms _-j' Number of baths ---I_ Lot size --_�T-s��`'� ._.------ � Water Supply: Public system El Community system El Private �aepth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam RR"lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes F] No gr New Construction: Yes ElNo &' FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) 4eptiTank: Distance from nearest well------------------Distance from foundation-------------------Material__-__-_--.--.___-------._.-.-__-_-.----.-_.--__. No. of compartments------ -------------------Size----------------------------:---Uquid depth------------- Capacity----------------------- Qlspo I ield: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_----__-__-._-_-. Number of lines----------------------------------Length of each line-------------`------ ---------Width of trench.---------------------------------- f�' Type of filter material------------------ ____Depth of filter material-----------------------Total length------------------------------�--,._- 40 i Seepag Pit: Distance to nearest well-J00--______Distance from fou anon_ �___---__� �r rle #o nearest lot li a .______,_. Number of pits----/----------------Lining material, Size: Diameter_------_---------------.Depth_-- -----------------. y Y , Cesspool: Distance from nearest well_________________Distance from foundation__--__,- .---_- Lining material------_------------------------------- El __--.-._.__.------_---__-_---. ❑ Y _.-_--.Li Liquid Capacity gals. Size: Diameter------ ------ -'--- -------Depth--------------------------------- ------ - q p Y- ---------- -----_---_--- Privy: Distance from nearest well-'---------------------------------------------Distance from nearest building-----.____.-----_------____________----. ❑ Distance to nearer# lot line---- " -------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe}:__._ i e --- -�� ---------- ------.--------------------------------------------------------- - -- I hereby certify that 1.have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations f the San,Joaquin Local Health District. 4J�San,' �.; ( Contractor) -- ---- -------------------------------- (Signed)-------- ---•------- t Ian. showing size of t, location of system in relation "we ls, buildings, etc., can b'eeplacedt on neve B _ ------------ rs side}. (Plot p g �. ► FOR DEPARTMENT USE ONLY f. APPLICATION ACCEPTED BY-------•- ---- ------- - - --------------- DATE -- -------------------------- -- --------------------------------- - REVIEWEDBY----------------------------------------- ------ - ------------------------------------------------------------------- DATE---------- e --------. BUILDINGPERMIT ISSUED---------------- --- -- ---------------------------------—------------------- ----------------- DATE- `O ------------------------------------- Alterations and/or recommendations- --------- - ----------- - ---- --- ----------------------------------------------- -------------------------------------------------------------------- 3�f ---------- ------ .--- -----cDr►f?_t, A_r.._T1_.t-�_ ..n_ ..l-hid. _�, -t`�.1� �#_------------ L)-�-D------Mn_�----!� - ----- p�..Pr r, - �1r� r- G�:r ---Q--Iz------ C-o-J --------------------------- -- ----- -----------------------------------------------------------------.---------------------------------- ------------------------------------ ------------------------------- ------- --------- --- FINAL INSPECTION- BY:-------- - - -- --------------=-- Date-- ------- --------1-- --=--------- AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street a 814 North "C" Street 4 Stoek+on, California Lodi, California Manteca, California Tracy, California ES--9-2M . Revises 1-57 F.P.CO.