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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year from Date Issued Date Issued _______..1. 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 County Ordinance No. 549. OSr- !y a JOB ADDRESS AND CATION___- -� ---__ _ Owner's Name ••-------•---------- _ Phone------------------------------------ Address---------- r-'-- Contractor's Nam .! -------"--------••--•------------------------------------------------------ Phone Installation will serve: 'Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: -1______ Number of bedrooms __ i Number of baths �-ilo� Lot size z _- '-. ----------------- Water _-""••"_Water Supply: Public system ❑ Community system ❑ Private IN Depth to Water Table ;1-0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E❑ No 0? New Construction: Yes X No ❑ FHA/VA: Yes ❑ No [❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic lank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well__O ------Distance from foundation__ b---------- Material--- No. of compartments-- ---------------- -]I -_---- ---Liquid de th----T-------------- Size q P Capacity._ - r%j Disposal Field: Distance from nearest wO.J-q.......Distance from foundation_l_0-------..-__.Distance to nearest lot line-_r____-._:_ Number of lines____A___ _ __ _________-- - Length of each fine----FQ--______.__--_._.Width of trench__.��"'__________-______ Type of filter ma_46'_,��___Depth of filter material_ rY---------"-Total length----/40--'_______________--.__-- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line------- ❑ Number of pits----------------------Lining material-------------.---------Size: Diameter----------------------- Depth------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation__------------------Lining material----.--------- ___.-___________.___. ❑ Size: Diameter Depth---------------------------- ----------------------Liquid Capacity----------------------------gals. Q Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line----------------------------------------------------------- Remodeling and/or repairing (describe):------'------------ ----------------------- --------------•----•---------- ---------------- --------------------------------------------- - ------------------------ -------------------------------------------------------------------------------------------------------------------------- ----------------------------- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,, and rules and regulations of the San Joaquin Local Health District. (Si ned -7�. . 9 }---- --- � .}-------- - --------------------- --------------------------- ---- - -------------- - -----{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 APPLICATION ACCEPTED BY -----------------------------------•----------------- DATE---_ REVIEWEDBY------------ -------------------------------- ------------------------------ ------------- -------------------------------• DATE BUILDING PERMIT ISSUED------------------------- - -------------- -- DATE--:- Alter mmen ns: 2s: t -/_ 0 " ?� - _- r � �--------�-------------------------------------`--------------- --------------------------------------------- -------------------------- -------- ------- ------- -------------------------------------------------------------------- ----------------------------------------------------- -------------------------------------------------------------- ---------------------------------------------------------------------------------- ----------------------- -- ------------------------------------------------------------- ---------------------•------------------------------ --------------------------'--------------------------- --------------------- fi r �' FINAL INSPECTIONBY:. - �- Date--- - -- ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 8-'54 F.F.Co.