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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) !d� this Permit Ex fires 1 Year From Date Issued Date Issued ----__f' 9 Application i pp s 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) ith County Ordinance No. 549. ' JOB ADDRESS AND LOCATION _. _ T------- .- --------- 4---- Owner's Name__.--- L ( ----- --------53-----------�--- - - - Phone ...... Address. --------•--•-•--•-- ' --- ----- -----•------------------------- ---- Contractor's Name ------------------------------------------------ ---------------------------------------•------------------------- Phone..--------------------------:------- Installation will serve: Residence ❑ Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other Number of living units: -- ----- Number of bedrooms -------- Number of baths -------- Lot size ___________________________________________.__.________.-._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobj>Kp Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes, No 0 ' FHA/VA: Yes ❑ No,�< , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) �' Septic Tank: Distance from nearest well___________Distance from found �d'f Material---/' ---4 r4 � ------- No. r�. ------ - - - ----- ------ of compartments---------,�---- -----Size-----. - _-- _:_!Liquid depth----- �--------------Capacity ------- Q -- Disposal Field: Distance from nearest well_,______ .__- Distance from foundation______fid_ _Distance to nearest lot line- ..... Number of lines_____t A----Length of each line___________�1� Width of trench---------. c�G w-------.-- Type of filter nnateriaL - L:.,--_Depth of filter material7 ._-.Total length__________________ _________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----------- Distance to nearest lot line----------------- El Number of pi#s----------------------Lining material----------------------.Size: Diameter-----------------------Depth---._'__-_---------------------- Cesspool: Distance from nearest weil--------------.._Distance from-foundation-----_--------------Lining material--------__-_--__________________..__ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------_------- 0 Distance to nearest lot line------------------------- Remodeling and/or repairing (describe)------------------------- --------------------------------------------------------------------- ---------------------*------------------------I----------- ------------------- ----------------------------------------•-----•--------------------------•---------------------------------------------------------------- ----------------------------------------- -------- ---Y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, S+ to laws, and les and regulations of the San Joaquin Local Health District. !(Signed)-•--------------�'---------_-- ----__+ (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 f - ------------- APPLICATION ACCEPTED BY------------ ------ ----- ------ ---------------------------------------- DATE---- I ----------------- REVIEWED BY-------------------------------------- --------- ------------------------- DATE _._ BUILDING PERMIT ISSUED----------------- ----__ • DAT 1. • --- E ------------------ Alterations �- and/or ret m rndatio T x �`-' - ----------------------------- ---------- ------------- ---------- -- - -------- -------- ,�. c.J ci ----------- ------------------------ - z -e -- /f Z FINAL INSPECT BY:_ Is'-'� ate --- ------- SANOAQUIN LOCA EA�LTH D�15 RIC 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.