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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /207 /� 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. f ,- 1 ! f� ___________________________________________ .JOB ADDRESS AND LOCATION------ ------------------�FC�� --------------------------------------------------- Owners ; -------- -----------t .)---" ---R --- Phone----------------- — ` ----------------------- Address a flf1 = Contractors Name----------- --- - --- - -' ---------------- -------- -------- - =�--------------------------------------------------- Phone-----.----------------------------- - Installation will serve: Residence Apar reL� nt House „f0'omL] ElE] E]mercial Trailer Court Motel Other r Number of living units: _ __ Numb`r,o'f bedrooms 44- umber of baths _Z--- Lot size ___/_ ..� __________________________ Water Supply: Public system 0 Commu�ty system ElPri�va fe ❑ Depth to Water Table -7-JV ff. Character of soil to a depth of 3 feet: Sandi❑ Gravel U7 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ " New Construct[o�Yes ❑ No [gw' FHA/VA: Yes ❑ No [�_ TYPE OF INSTALLATION AND SPECIFICATIONS: _ . (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) ` 11 ,0 y epti ank: Distance from nearest well-----------------Distancwfrom foundation--------------------Material ___-_.__-__-______:_:__________.__-_____-__-_. ' ' No. of compartments-------1--------_______.._Sjze__!-----------------------------Liquid depth .-----------------------Capacity---------- isp a Field: Distance from nearest well___-. ___--Rstance from foundation __ Distance to nearest lot line_„��__-.-__- �� Number of lines__________ e.' -- L=e" th of each line___- ____ ___________Width of trench._,__ 1 9 1 s. YP �- � . p��e_r, material-------��--------Total ------------------------- !: Seepage Pit: Distanceftloenearaestriwel __ �-D.istan e f� 'm f ndation.__._',�.,�____.. istanye to nearest lot line____�______.. �• [� Number of pit s- __de _______�-Lining material__-_.Size: Diameter _��...___Depth-... v ----_____,________ 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--------------------------------------- L] Distance to nearest lot lire-- --- ---------------------------------------- 1--------------------------------------------------------------------- ribe]:---------- ----------------------------•----------------------------- -------------------------- Remodeling and/or repairing (desc •-•-----------------------------------------------------------------' -------------------..-------------------------------------------- ------------------------------------------------------------•------1A-----------------------•---------------------------#----------------------------•-------- --------------------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------- ---------------------------------------------------------------------- --------- 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 rulesand re ulations of the San Joaquin Local Health District. (Signed) r Contractus - - ----------------- ------ - By:---------------------------------------- ------------------------ -----------------------{Ti+leJ = ---------------- - (Piot plan, showing size of lot, to n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE--------------- --------A------------------------------ REVIEWEDBY-------- ------------------------- DATE-------- --- - - ------------------------------- BUILDINGPERMIT ISSUED------------------------------- ------------------------------------------------------------------- DATE--------------- ------------------------------------------- Alterations and/or recommendations:--------=- ------------------------------------•--------------------------------------------------------- ------------------------ A ----------____________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________•______..-._-._._--_-_____-____.______-.._.__--.__-__-___..._________-_-__-_-_-__._____-._._______________.----_.-.___--.-._.--__.--___--.__-_._.-__--- FINAL INSPECTION BY--------------- ------------------------ Date--------- ---- _ --------- 0_7-- SAN JOAQUIN LOCALHEALTH DISTRICT 1 130 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 , Reviseci 1.57 F-P.CO.