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sPermif-No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ---- This Permit Expires 1 Year From Date Issued to construct and install the work herein described. Application is hereby made to the San Joaquin Local Healt District for a permit This application is made in compliance with County Ordin ce No. f __ JOB ADDRESS AND O A=N---- -c---- PAt --------- - �: ---- ------------ ------------------------------------------ -------------- Phone_.' - r Owner's Nam _ --- --- ._ - A __ _____________ Address. --- ----!�---- -- - - _ -.�✓�� -- ------------------- -------------------------•---------------------------------------------------------------- -------- ----------------•----- --- ----------•--�------------ J.._____-,.a -------------------•----------- Phone Installation will ser-ve: Residence- = A artment.House-❑ Commercial Trailer Court ❑ Contractor's Name______________ __ -.� -- - - otel ❑ 'Other ❑ + p Q_ '�. Number of living units:- Number of bedrooms _ . Number of baths ------( Lot size --. -- Public s stem�}} Community system ❑ Private ❑ Depth to Water Table _ ft. Water Supply yL. I Clay Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,[] Clay Loam ❑ y ❑ Previous Application Made: sNo ❑ New Construction: Y No PHA/VA: Yes ❑ No I l TYPE OF INSTALLATION AND SPECIFICATIOf S: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t �Septic TZi: Distance from nearest well.___?----------.Distance from foundation___________________Material___-.___-.___s_.._____.---------- --------•-- !�'(, No. of compartments - ! Size--•--------------------j----- Liquid depth Capacity. p4sal ie Distance from nearest well-_J----------- Distance from foundation___________________.Distance to nearest lot line_.________------- Nutanc of lines---•-------•---- -----------Length of each line-----------------------------Width of trench_'___---------.--------- _ De th of filter material----------------------Total length------- -------VIP— -=-•----- Type of filter material------- _ -�_----- p . I istanc r m f ndation_ --- D nc to nearest Kline_- -.----- V} Seepage Pit: Distance to nearest well__________________ Deptn___-____ .----- I Number of pits_____.-------------Lining materia___ e: Diameter._._.__ - s ing Cesspool: Distance ft near st well____ ___________Distance from foundation__------ Linuid Capacity gal • CA ❑ Size: Diameter------------------------ ---------- 'Distance = q p Y Privy: Distance from nearest well__.k-.______-___- 'Distance from nearest building--------------------------------------- ---------------------------------- ------------ ------------ -------------------------------------------------------------- Distance to nearest lot line__._------------------- -; 1 }------•- --------------•-------- I Remodeling and/or repairing (describe --------- ---------- - ____ ------------- --------- ------------------------------a------------------ I hereby certify tha I have prepared this application-and;#hat the work will be done in accordance with San Joaquin County ordinances, State I ws, nd rules a d r lat%!f YJioaquin Local Health District. i (Signed,- - (Owner and/or Contractor) S� ned) - ---- ---------------- --------(Tit e--------------- ----------- ------------------ --------- ---- (Plot plan, showing size of lot, location of system in relation to-wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY rDATE-------------------------' --------------------------- APPLICATION ACCEPTEDBY-------------- --- - ------- DATE------------------------ ----•--------------------------- DATE ----•-------•----•------ REVIEWED BY ------------------------ -- ---------------------------------- •---- --•--- DATE----------------- ----------- -------------- ---�--•------ E BUILDING PERMIT ISSUED-------------- . �----•,----------- - --------------- 4 - ---�------------ -- -----•------ - Alterations a d/or r commendatio _ __ 4--------- .� Y________________ ________- _ -__ _ -_) 1_ r _ ____-__ !"•---•__-__ _____ -------•----------• --------------- __•__••_-_-• .__• _____•__-_•__--______- -------------------------------------__•_____ ________________________ S Date-- -- ------ ------- --------• ------- ----------- --------- - _____________ FINAL INSPECTION ----------- ----- -------- ----- -----•-- ------ -------------- SAN --- = --- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California � Manteca, California Es-9-2M Revised 6-'59 F.P.CO.