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APPLICATION FOh. SANITATION PERMIT Permit No. �. (Complete in Duplicate) c� 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. q-'-yc ---- -------------------_-- JOB ADDRESS AND' � CATI N----�-1�,�---�---�.�j- ----- --- ---I Name � T --- ------------------------------- Phone . ,/ Address-- ---- --•--- — --•--. = ------ -------- -------- - ----------------- ------------------------------------------ -----•- ---•---------------- Contractor's Name------ ---- - -- - z�`---------------- ----- Phone.._ —-� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _/____ Number of bedrooms _Z Number of baths ---/-- Lot size ----- ---------.________________ Wafer Supply: Public system Community system ❑ Private� Depth to Water Table Z— Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob9v Hardpan El Previous Application Made: Yes ❑ No� New Construction: Yes No E] "HA/VA: Yes ❑ No 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__________________11----------------------------- No. of compartments--------------------- -- Size-------------------------------Liquid depth--------------------------Capacity:-------------------- Disposal ield: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line____€--_._--..... Number of lines-----------------------------------Length of each line-----------------------------.Width of trench....-------j--------------.-------- -------Depth of filter material-----------------------Total length Type of filter material----•-------___-�- p 9 I ----- --------•--------- )" i Seep e Pit: Distance to nearest well ��__._._.f_-Distance from fo dation_ ----------D1 to nearest lot line__��_�___._ Number of pits-------! ------------Lining material - --------- - ----Size: Diameter__'�- --------Depth__�� rr�- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material------s------r___.-.____-___________- ❑ Size:,Diameter-------------------------=---- ------Depth--------------------- ----------- -----------------Liquid Capacity--- -------gals. Privy: Distance from nearest well _______________________-____----------------Distance from nearest building----------i------------------------------- ❑ Distance to nearest lot line-------------- -- ------------------------- ------------------------------------- - ----------------------------------------------------- < - Remodeling and/or repairing (describe):__. - ' -- ---- - -- °- -- ..... - - •- ----------- ---- ` ! ------------------------------------------------------------------------ -----------•---•- --- •----------------- ----- ----------•/ ------- ----- f ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------j-.---------- I hereby certify that I have prepared this applicati and ha+ +he work will be done in accordance with Sari Joaquin,County ordinances, State laws, and rules a ulatio s of f San aa�quin Loc ealth Disfric+. (Own /or Contractor)(Signed)-- --------- -- By ------- ------- ------- - ---- --------- --------------------------------------------(Ti+le� =--------- - -- ---- plan, sho ing „l ion of system in relation to wells, buildings, etc., can be place a erse e). (Plot P .r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•---------------------- DATE--------- `:-- -- 7 REVIEWEDBY--------------------------------- --------- -- ---------------------------- DATE------------ ------- ------------; _------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- - ----------- ------------------ Alterationsand/or recommendations c ---------------------------------------- -------------------------------------------------------------------------------------------------------------- - -F- �-A ---- ----------------------- - - -----------------------------------------------------•-------------•--- --•----------------- --------------------- �_=:_ = 1= _ ------------- --- ----------- ------------------------------------_:______:___:_:::______:___ _:_____:____________::________ _ FINALINSPECTION BY------ ----------- ----------------------- ------------ Date------- -------------------- ' ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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 6-'59 FY-Co.