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APPLICATION FOR SANITATION PERMIT Permit No. _.- -�----/ f� (Complete in Duplicate} Date Issued ----.l--'Z�1-- 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. 5 49. , S�e7 ---------- ------ JOB ADDRESS AND L- - ----------- - ---------- ----------------- Owner's -- Phone°y._j.9 Name �� -- ----------------------7.4116 -- - ------ ----------------- Address------------------------ - - ' .c .--- --- - --- -------------------- Phone/. _-- Contractor's Contractors Name-------------•----//--. - - -------- - Installation will serve: Residence ®-"Apartment House ❑ Commercial ❑ Trailer Court* [j Motel ❑ Other [INumber of living units: _/-__ Number of bedrooms _ Number of baths _.�___ Lot size __, d_- -- `�©-------------------•- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table � ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam ElClay Loam ElClay [) Adobe[Hardpan El i Previous Application Made. Yes ❑ No R----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.) pti Tank: Distance from nearest welt-----------------Distance from foundation--------------------Material------._--__------_-.---__----------_--.------. No. of compartments -------Size--------- Liquid depth Capacity = t _ ---- / Disposal Id: Distance from nearest well--sem d-____-Distance from foundWidth `_._Distance to nearest lot line----- -----� Number of lines--_------,C__---- -__-�-(-.__Length of each line--_._____�4)-----��---Width of trench----- - - ---------------•-- i Type of filter materia4-��- Qe` -Depth of filter material-- _/�_---_---Total length------ --_----._---- , i i9A--_.�__.D1s�n J to nearest lot line--------------- i Seepage Pit: Distance to nearest ell-_-�D_--_--_-ti Distance'' foundation--. �� Number of pits Lining materiala�-°-C------Size: Diameter---- - Depth `' .5 - ` Cesspool: Distance from nearest well----------- from foundation-.-_-----_----5-_..Lining material------------------------------------- 0 Size: Diameter------------------- ------Depth-----------------:----------------------------------Liquid Capacity--- -------------------- -gals. Privy: Distance from nearest well---------------- -------------------Distance from nearest building------------------------------------------ ------------------------------------- C Distance to nearest lot line------------------------------------------------- -----------•----------------•-------.- - Remodeling and/or repairing (describe]:--__--------_----------------------------- --.--.-------------•------------------------- ------ •------------------------------•----------------= 1 ------------------------------------------------------- --------•--------•------------------•---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and rules and regulations of the San Joaquin Local Health District. � Oactor} (Signed) - __ ---------------�.------ -- - -------- ---------------------- /_1 ------Title (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTER BY -------- DATE ------------------------------------- i DATE------------ REVIEWED BY---------------------------------------=-------------- - �� BUILDINGPERMIT ISSUED--------------------------------- ---- :--------------------------------------------------------- DATE ` 5 Alterations and/or recommendations:--------------------- � -----------: -------------- �� - ------------------------------------------------- ----- ;a - ------------------------ ----- - ------------------------- (::?......7. FINAL INSPECTION BY:.-- •------------ - - Date-- _.!, _-. -------------------=------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California - Manteca, California Y ES-9-2M , Revised 1.57 F.P.CO-