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U APPLICATION FOR SANITATION PERMIT Permit No. ::....-?'_.Z ' (Complete in Duplicate This Permit Ex ires 1 Year From Date Issued Date Issued ___` _r._._.._...___ 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 complia'i ce W� ty Ordinance No. 549. JOB ADDRESS AND LOC kON_._ ----- � � Owner's Name -----------••----------- - ----------- ----------------------------- -------------- Phone------------------------------------ Address------------ -------G--- - -------=--- -r _ ---------•-•--•------------•------------••------ Contractor's Name_ ------------------------------------- � � C, � - -----r I'------- ------------------••---------- -----. Phone----.--•----•-•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1----I1 Number of bedrooms _-_- Number of baths ---L Lot size _•_------__------------------------------------------------ Water Supply: Public system J? ,�Community system ❑ Private ❑ Depth to Water Table #14777t. y' Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(--Hardpan ❑ Previous Application Made: Yes ❑ No E9— New Construction: Yes ❑ No D— PHA/VA; Yes ❑ No ,E TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) it Septic Tank: Distance from nearest wall_ Distance from foundation--/Q-_--------.Material_. __ ___________ ______________ No. of compartments_________ ------------Size--------3_xs_X.J'F---Liquid depth_------T ---------Capacity.,k Disposal Field: Distance from-nearest well...i_----- -----Distance from foundation-10--,_:_`{._.Distance to nearest lot line+----------- �] Number of line______:=____'_._ _--- Length' of each line-------I--—__-.-/_.__:_.Width of trench..__�i_.5�-'________.____--. 3.,5 Type of filter materia!_______ fir_ ____Depth of filter material---- .............Total length---. _&-- to nearest well---.-_�--._.___Distance from foundation-_�1I_---__--.-..Distapce to nearest lot line Number of pits--------------I----------Lining material_-_-- .( _ '.Size: Diameter.-- _ L Depth--------- :?/fir_--__ Q, Cesspool: Distance from I nearest well-----------------Distance from foundation- ---------------Lining material_----_-_____--_-_._------..__--__-_--. 1 ❑ Size: Diameter------------------------- ...........Depth------------------------------------.----------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line------------------------------------------------ -------------•-------------------------------------------------------- ------------ Remodelingand/or repairing (des.Ilribe):------- ---------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- -------------------•--------- ---------------------------------------------------------------=-_------------------------------------- -----------------------------------------------------------:11----------------------------------------------------------------------------------------------- --------------------------------------------------------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 laws, and rules a`dulations of the San Joaquin Local Health District. " (Signed) I re ___ Owner and/or Contractor B . ----------------------- - - -------------------------- I . '----- ---------------------- ----------- ------------------- ---(Title------------------------------------. ....................... (Plot plan, showing size of lot- loc-ation of system in relation to wells, buildings, etc., can be placed on reverse side). ,. FOR DEPARTMENT USE ONLY 01 .11 APPLICATION ACCEPTED BY- ,` C-}-- — --------------------------------- DATE-------- ---------------------- REVIEWED BY -IM -------------------------------•----------- ----------------------------------------------- DATE-----------------------------------•------------------ BUILDING PERMIT ISSUED------------ ----------------- = -------------------------------------------------------------- DATE------------------------ -- ----" •- ----------------- ? Alterations and/or recommendations-------- --------- ------------- -'-------------------- ------•-------------- ---------------------------------------------------------------------------- ---------------------------------------- IM -------------------•------------_._-_--_---_____-._-__-------i_____---_.-.L_-----_•._-.--_-_-____-----__._____..-_-___--------_--_--_---____--.---..._-_---..__.-.--_-------___-__---_--.----------_---____--__---______--._ ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ I FINAL INSPECTION BY:___ --- - ---- --- ---- - -------------- ----- -� Date-----� .`_ -_y` � SAN JOAQUIN LOCAL HEALTH DISTRICT ' 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 Revised 8-'59 F.P.Co.