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41( APPLICATION FOR SANITATION PERMIT f- Permit No. _.1 ....._-... (Complete in Duplicate) ] , 7j Date Issued .._.. 1--_ 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. ' JOB ADDRESS AND LOC TION.--...-._. Z y ---------------•- 5 Owners Name . . -...... :�. .. "-� Phone �. _:°. � ' Address------------------------------------------ •-•---- ---------------------- ... -----------•----------------- ---------------------------- i Contractor's Name-------------------------- ..........-------------------------------------------------------------------------------------------------------- Phone.._-------------•----:.. Installation will serve: Residence,( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _„`Number of bedrooms-- Number•of baths Lot size -------- --------------_--_- Water Supply: Public system R Community system ❑ Private ❑ Depth to Water-Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe„�j] Hardpan ❑ Previous Application Made-.,Yes P No ❑ New Construction: Yes ❑ No [9 FHA/VA: Yes ❑ No I TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i. Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. o partments--------------------------Size--------------------------------Liquid depth---------------------.----Capacity--------•- ------------ --------------------Distance to nearest lot line------------__--- Disposal Field: Distant --------Distance from foundation Number of lines-----------•-----------------------Length of each line---------- -----------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material------------ ---_.----Total length------------------------------------------ Seepage Pit: Distance to nearest well----- ----:Tr!n-n...Distance fr foundation----- - `.-.Distance to nearest lot line--.- --� _ __. Number of its....---- Linin material---- -Size: Diameter.�d-.".------_Depth...._..--_ -�":-�.------ Cesspool: Distance fram❑ nearest well _ _ _ _-------- -----Distance from foundation--, -------------- Lining material----- --.--_-.----.------------_-_- I F Size: Diameter �--------------- -----------De th--------------------- ------------- ----------- Depth Liquid Capacity - gas. Privy: Distance from nearest well-------------------------------------------------Distance from nearest build ing------------------------------------------ ❑ • Distance to nearest lot,line = ------------- =------------------------------------` Remodeling and/or repairing (describe):---_-. -------- -----___._ - -• --- '.r � ,— mak�-� -_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta -laws, and rules and regulations of the San Joaquin Local Health District. (Signed)•----- - --- 1 --------------------- --------- (Owner and/or Contractor) By: 4 (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, APPLICATION ACCEPTED BY--------- - ----i- -- ------ --------------------------••------------ DATE--------------- 1 r------------ IREVIEWED BY-------------------------------- ----------------- ---------------------------- -------------------------------------------- DATE---------------- -------------------------------------------- BUILDING PERMIT ISSUED---------------------------------- ------- A•TE--------- ------------- t Alterations and/or recommend�tio -4l-. -------- -- �✓"`+ "F'- ------------- - ----- ------ -x`- - - _ FIAL INSPECTION BY:-------- - ----- --•---------------------------- -- ----•-.-.- Date-- --------------------------------------/-------- ------ --------------------- y�y/Z SAN JOAQUIN LOCAL HEALTH DISTRICT rte, e � . -,s.� � - t30 uth Am®rican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisecd 8-'59 F.P.Co.