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APPLICATION FOR SANITATION PERMIT Permit No. ._f...............`� (Complete in Duplicate) Date Issued ----------------------- This Permit Expires 1 Year From 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. ,fQ C f JOB ADDRESS AND LOCATION----- _,5/ .. , 2 T '/ � ---------------- - ----------------- Phone--------- -------------------------- Owner's Name. ---•--- l - -------- a ---- Address•--------- < ~ --.-. Phone_ 7 Contractor's Name.--- -----�-�----��---- -----.�.t��cS_'_�.-- ..5--..� �'-------•- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units: _f----- Number of bedrooms -Number of baths -- _--_- Lot size -----.- ------- Communit system PrivatXyL, Depth to Water Table _ Oft. Water Supply: Public system ❑ Y Y ❑ soil to a depth of 3 fest: Sand ❑ Gravel [] Sanam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of P Previous Application Made: Yes ❑ NoPr New Construction: Yes ❑ NoFHA/VA: Yes ❑ No ❑ PE OF INSTALLATION AND SPECIFI"CATIONS: (No septic tank or cesspool permitted if public sewer is available within 20 feet.) Sepi Tank: Distance from.nearest well__-----Distance from found _- (� ation _a---- -. pp No. of compartments Size � 8-'------ Liquid depth--. 5''r--. ------Capacity-G � --------- I � �--_-----.Distance to nearest lot Dispo al Field: Distance from nearest well- -.-_.-Distance from foundation---� - �- ' Length of each•line-^'-_-�t��`------�Y---==--Width of trench.-Z-�r------�------------- Number of lines-------._/-------------------- g Type of filter material__�{�--------- P :ter material____�f------- ----Total lengthf� Depth of fl Seepage Pit: Distance to nearest well-- 10®_--._---Distance From foundation __..--__.Da�cg�,to nearest lot line_ -�__-.- Number of pits C/ Lining material_- t"--Size: Diameter----------------- -----Depth __ 5--------- ` Cess ol: Distance from ne.aresf,well-1---------------Distance from foundation-.-_.--------_.---.Lining materiaU_----._________------------------- +. -Depth---------==--------------- ----------------------- size: Liquid Capacity'' gals. k ❑ Diameter-.- --;•----- --------- -----------s y_----__D�stance=from nearest building--------------------------------------- w ' Privy: Distance from nearest ell:-__.-_------------ ---_ _. 1 ❑ Distance to nearest lot,line-------------------------------------------- -- ------------------------- ----------- - ' , „ IL -..�:. ._t I Remodeling and/or repairing (describe}--------------_.*'---------- 4 -----•--------a---------- ------------- --- -j------------'---------------------------------------- --------------------'-- ------------ --- her '--------------------------------------------------I-----------'-----------------------------.- ` ..._ I hby certify -at I have p are t 1s plication and that the work will be done in accordance with San Joaquin County f ordinances, State s an rue and regulatio of the San Joaquin Local ealth District. - ---- 3. - - Contractor) (Signed) caner r -. an /s- �---- ---- --(Title)---- (Plot plan, showing size of lot, location of sys m in rQl tion•to wells, buildings, etc., c n be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- ---------------------------- APPLICATION ACCEPTED BY-- -- ------ ----- - ---------- - ---------------- DATE_ ------- --- REVIEWED BY-------------------------------- ------- BUILDINGPERMIT ISSUED---------------------- --------------------. DATE------------------------------------�-------- ------------- ----------------------- ----------------------------------------- -------••-•----------------------------------------------------------- Alterations and/or recommendations---------------- ----- -------------------------------------------------- FINAL INSPECTION --- Date--- -----�- �-------- ----- -------------- -------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street 130 South American S+reef Tracy, California S+ockton, California Lodi, California Manteca, California Y. E5-9-2M Revised 6-'59 F.P.eo. i