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APPLICATION FOR SANITATION PERMIT Permit No. ....1__ z_QO (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued ---_1.__��.,-i--- 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 compliar'Ce wi.th,County Ordinance No. 549. 0 4S ZZ© --('7 ' JOB ADDRESS AND CA lON__I ,�r .• � - . Owner's Name___A___ - - Phone-----•-------•-------- - --- -- -j -----------------•--------•----- ------ - ----- ---------- ---------- ------ Address--------. Contractor's Name_ ------------•--------------------•-------------------------------.-----------•------•----••------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel E❑ Other ❑ Number of living units: I_____ Number of bedrooms __1t_ Number of baths _)__-_ Lot size ��*-__- / ------------------------ Water Supply- Public system E] SL Community system ❑ PrivateA Depth to Wafer Table _0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ElNo New Construction: Yes,Qf�] No ❑ FHA/VA: Yes ❑ No ❑ �j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpublic se_wer:is available within 200 feet.) -- ,r Septic Tank: Distance from nearest well_:' _� -.-Distance f m Ifoundation__--�d�__-.Material-_ __ _ _____ � ' ' No co --- ------------ -Size_ � ------�-"-- -� � , " , ompartments__.,--- � -------_-Liquid depth------�--------------------C, C__epacit_______ __y__. /� - Disposal Field: Distance from nearest well ' _?� _--___Distance from foundation$_0_�__-_----Distance to nearest lot line----- Number of lines_i _-- Length-of.each line__ Aft�------------------Width "of trench__ ____eil�____---___-__ Type of filter materi� ------- Depth of filter material_ _.-_/�________-Total length_-�_o ._ --------------------------- Type .__ _________________ Seepage Pit: Distance"to nearest w l________ ______ Distance from foundation--------------------Distance to nearest lot line______-_.________ ❑ Number of pits:N __-_------------ -----Lining material---------- ------- --- Size: Diameter------------- --------.Depth----- -------------------------- t Cesspool: Distance from nearesf well --- from foundaticin------------------- Lining material____--._--_______-__ -------- Size: Diameter ` . %`:Depth ----------------------- - ---- -----------Liquid CapacitY------------------- Privy: Distance from nearest well-_______';__ __1 -------------- _____________Distance from nearest building ❑ Distance to nearest lot'fine_ __________________________ ------------ Remodeling and/or repairing {describe}_---------------- --------------------------------- ----------- i ------------------•---------- a_. -<, .- ------------------------------------------- ---------•-------- --------------------- ------------- ----------------------------------------- ------------------------------------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfajebwsi, and rules 4Iregu6tions of the San Joaquin Local Health District.' y (Signed)_._ - ---------------------------------------------------------------------------- (Owner By---------------- -----------------------••----------------------------------------------------------------------------- --------- Title an /or Contractor) := Plot plan;showin y - p g-size`of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY__ -------------------------- DATE-- .:A-`"w_-q REVIEWED BY---------------- DATE - ------------------------------------------------ ------------ - -------------------------------------- BUILDING PERMIT ISSUED------------- ------------- ---- -------•-- DATE Alterations and/or recommendations:--------___-___...._ ------- -------------------------- ------------------------ ----- ----------- ------ ---- - - -----------•---------------------- " - ------------- FINAL INSPECTION BY: ----------------------- Date--- SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Street 300 West Oak Stroef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.