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APPLICATION FOR SANITATION PERMIT Permit No. .. ;7� (Complete in Duplicate) 9 Date issued This Permit Ex ires 1 Year From Date Issued .___;/�-.71... � a 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 compliant* with County Ordi nce No. 549. Cir€,Qat. �. , JOB ADDRESS AND LOCATION - ---- ----- -••- ----------- a .............................. . ---- . ------------------------------- Owner's ----------- ---2--� �r Owner's Name- ----------- ..... -------•----------------------------------------- ------------------------------------- Phone---------------•---------------- Address--•-•----r-- . .- '1. --- ---=------------- --- � v " Contractor's Name------------------------------------------------------------ --------------------------- ---- ---------- Phone..................---------.------ Insfallafion will serve: Residence ❑ Apartment House ❑ Commercialsailer Gourt ❑ Motel ❑ Other ❑ l ~%rri o 4 ing units: -------- Number of bedrooms ________ Number of baths _______ Lot size .__ __. ______________________.__ ! Water ,Supp y• Public system ❑ Community system ❑ Private Depth to Water Table i`a_�__ ff. ! „,nom_- f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ER Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan {] Previous Applications Made: Yes ❑ No (g) New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: __,.(No septic tank or cesspool-permiffed if public sewer is available within.200 feet.) Septic Tank: Distance from nearest weal fl__0______Dis# fro fou dation.--j��------ Material_ -_____.______ No. of compartments_.__ #: .r.��-______ -------Liquid depth----- ------------------Capacity. +�j t p� Disposal Field: Distance from nearest well_/.(�___._.. _Distance from foundation�`.�s c,.___.Distance to nearest lot ine,"_j...... ?+ �) . Number of {Ines----/--------------------------Length of each line__ ------------.Width of trench--- --------------------- Type of filter materi� _Depth of filter material__ __________._Total length__,_ ---------------------------- Seepage _______________________ Seepage Pit: Distance to nearest well---------_-----------Distance from foundation-----------------_Distance to nearest lot line_____._________ ❑ Number of pits----------------------Lining material------------------_----Size: Diameter--------------.--------Depth----.---_------------------------ I Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-----------.__..____.___._________._. ;1 n ❑ Size: Diameter------------- ------------------------Depth----------------------------------------------------Liquid Capacity_--------------------------gals. I Privy: Distance from nearest well------------------------------------------------- from nearest building__._-_-______-.-______________.._._____._. ❑ Distance to nearest lot line------ -----------------------------------------------------------------------------•------------------- ------------------------------------ i Remodeli gnd/or repairing {describe),avt(_--- --- --_429.1 C-s--- 2111UA� W/-%,U -----------------------------------------------------------------------------••----------- -------------------- ---•------------------------------------------------------------------------ ------------------------------------ -----------------------------------------------------•-----------------...---------------------------------------------------------------------•---------- --------------------- 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 req-----42�� _la+io ofithe San Joaquin Local Health District. 5i ned r��t t [`[.. -- ----- --- ------------------------------------- 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 APPLICATIONACCEPTED BY + ------------------------------------------------------- DATE-- ----------------------------- REVIEWEDBY-------------------------------- ------- ---------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------- - Alterationsand/or recommendafions:-------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------•---------------------------------------------------------------------------------- -----••-------------------------•------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------- ------------------------------ ----------------------.--------_--------------------------------------------------------------------------------•----------------------------------------------------------------------- -------------------------------------------------------- ----------------- - ---------- --------------------------•---------------------------- --------------------------------------------------------------------------- FINAL INSPECTION BY; �' Date �� rI SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3b0 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 8-'59 F.P.Co.