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(' APPLICATION FOR SANITATION PERMIT Permit No_ ___ (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. JOB ADDRESS AND LOCATION________ __ __ _____ ___ ___ ____ _ __ - ----- `� i - Phone ------------••-------•----- t Owner's Name--------- -- ------- - ----- -- ---------- 4�-2 '' '�-��------- ----- -------------------------------•------------------------- -------------- ----------------- Address ---------------'----------- - ---- , Contractor's Name-_ �`I------�r-�---- ---------- Phone_ ...fa-- :r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms_ Number of baths _/___ Lot size ___ , r---?L----.-1---"r- --------- ------------ Water Supply: Public.system ❑ Community system ❑ Private [I Depth to Water Table _______ ft, Character of soil to a depth of 3 feet: 1 Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No W--F'HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) isT Distance from nearest well_________________Distance from foundation--------------------Material ___:-------------------------------------------- , No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- S sal e d Distance from nearest well_--O--'.Distance from founda&�6 -----Distance to nearest lot Number of lines-----I_______________-_---____---Length of each line--- --r---�/- Width of trench-_o.�- -- f _ �1�3 � Type of filter material ,_��______Depth of filter material-----,/¢------- Total length___________________------_____��--- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- rlNumber of pits----------------------Lining material--------------- -------Size: Diameter--------- -----------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__________________ Lining material---_-___________________---__________ ❑ Size: Diameter-------------------------- ----------Depth--------------------- -------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-___-______-_______--________-___------- ❑ Distance to nearest lot line---------------- -----------•-------------------------------------------------------------------------------------------- ------------- Remodeling and/or repairing (describe):-------------------------- ---------------------------------------------- ------------------------------•------------------------------------ ---------••------------------------------------------------------------------------ - --- . ---------------------------------------------------------- ----------------------- - ---- ---- � "G'`' -----------•--------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances laws. and rules and regulations of +he San Joaquin Local Health District. _- _ -ti�. _�/- r- ta -------------------------------- - Contractor) (Signed)--W: --------- ------------ - -•------------------------------ ---- - - - (Title)---------------- - - ------:---------------- --- (Plot plan, showing size of lot, location of system in relation to w buildings, et ., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------C-- -- - ---------------------------- DATE------- _-- -_3_—.to_I------------------------•- REVIEWEDBY------------------------------ - --------------------------------------------------------------- DATE----------------------•------------------------------------ BUILDING PERMIT ISSUED-•----------- •-------------------------------------- ------s --------- -------- DATE------------------------------------------------------------- -------------- and/or recommendations: x t 5 �h �o --- &.K a ° FINALINSPECTION BY ------------------ ---------- Date--- b---------- -------------------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Straot 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Revised 0-.'59 F.P.Co. 4