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APPLICATION FOR SANITATION PERMIT Permit No. ..� n..TP. 1 [Complete in Duplicate] This Permit Expires 1 Year From Date Issued 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 9rdinance No. 549. JOB ADDRESS A ,L C ' I a SsF Owner's Name----�- ---------------------------------•------•----•---•--- - --- ------- -------- -------- ------------------•-------------- Phone Address----------�5` 7 ° ems ----------- ------------•---•---•--- --- ' Contractor's Name 6 7f Phone d Installation will serve: Residence [l—Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel.❑ Other ❑ Number of living units:�J_ Number of bedrooms .,,2_. Number pf_bafhs,,. Lot size ��°xl�_•-_--_" Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table v`?? ft. Character of soil to a depth Qf 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gj—Hardpan ❑ Previous Application Made: Yes ❑ No ®' New Construction: Yes ❑ No P- FHA/VA: Yes ❑ No 2— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance ..from nearest well-________________Distance from foundation--------------------Material Nompartments--------------------------Size----------------------------•...Liquid depth_ -----------------------Capacity----------------- r No. of c ' --- a acit.._ ------•------ ........... Disposal Field: Distance from nearest well-----------------Distance from to - _.. foundationD ❑ Number of lines------------- ---------------------Length of each line ----------------------- -. eest lot .line_________________ s � ematerial D ------Width of french-- `_______.___---- ---------- ---- poermaera-----------------------Total lengh------------------------------------------Seepage Pit: Diae #onearestwell_____ -""__ Distance from foundation-.�.�_____________Distance to nearest lot iine___�_ ' .----- Number-of p,ts- ------1----_-------Lining material______ Lr -- Sizer Dia eter.__s.7,�- Deptn__-�_c3 _�_-_______,--• Ce I sspool: Distance from nearest well_________________Distance from foundation,..F4`�S Lining material.......... Size: Diameter--- - = -=---------------------------Depth--------------------- -- ---`--f `-`----------------Liquid Capacity -----gals. Pri V,y Distance from nearest well,__ _-----------------------------------------Distance fro} nearest building--------------------------------------- S[] Distance to nearest lot line ..____ $' --------- Remodeling and/or repairing.(describe):______-r_____. _- _ � ___-_-_--j-------- ,, --------•--------------------- --------- ___..- ----------_________________ 1 S ____________________________________ __________________________________________c______._______.______„________________.•___-_--.__-_-_______-________________________-______.___-__-...____.______-__-___.________.-__.____._-_____-____.__________..._-._ 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'-rules and regulations#of the San Joaquin Local Health District. [Signed]-------•------ i �= -�---_,-------• - - ------------- ---------- -------------- --------------- --------- - ------(Owner and/or Contractor) By-----------------•----------------------------------------- - Title _ ______ - ------------------------------------------------------------------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc„ can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... ...__. . DATE-------------- - ---y --------•=-------------------- .2 - ls-h------- ---------------- 4 IEWED BY =--------- -------------- ------------------------------•------------------------------•------.- DATE------ -- BUILDING PERMIT ISSUED----------------- --_ _ _ _... __< ---------------------- iSATE ---- ;';,a Alterations and%or recommendations -------------------- ------------------------f-------.---- ---------------------------------- fr --------- '� ---------- ----- --_ ----------------------------------------------------------- ---- -------------- ------------------------. . --------------------------- -------------• -------- ------------------------------------- FINAL INSPECTION B ----- - ---------------- ---- ------------------------- Date e`€ ...................................... _ SAN JOAQUIN LOCAL HEALTH DISTRIC 130 South American Street;1 Ai 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California t, . - ' Lodi, California gg 1 - Manteca, California Tracy, California n ES-9 -2M, Revised-6;`59 FP Co, �y s