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APPLICATION FOR SANITATION PERMIT Permit No. This Permit .,1.:.� L p (Complete in Duplicate) ! �.. Expires 1 Year From Date Issued Date Issued _______ __-__�u.O 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 ........ ..... Owner's Name ---/_er�11-60....... Address v .................. �.�......-gon�- =g;..r.' Contractor's Name----- Installation will serve: Residence 1"!'0' Apartment House ❑ Number of living units: I Number of bedrooms y_..--- r -------------------------------------------------------------- Phone .................................... - - - ------------------------------ Phone ---•---------------•---•-- -------- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of baths Lot size Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table .liq ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No X FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________ Distance from foundation -------------------- Material ______-_____________.___________________.__.__--- ❑ No. of compartments -------------------------- Size ................................ Liquid depth -------------------------- Capacity ------ -----_-.-_--- Disposal Field Fi Seepage Pit: 0 Distance from nearest well ----------------- Distance from foundation_...................Distance to nearest lot line. Number of lines___________________________________ Length of each line ------------------------------ Width of trench ------------------------------------ Type of filter material ____-_______r_�_r__._______-Depth of filter material --------- _------------- Total length ____.__.___ __..____...._........___ Distance to nearest well ---- �C�_---------- Distance� fro un ation._._t3 V_�_..___.Distance to nearest lotline-line-____!91___. Number of pits ------ I-------------- Lining material;; Diameter ----- 3.3_��-------- Depth------ -------.-------._------ Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ______-__-____.-________-_-_____--_-. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity ---------_----------------gal . Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building _________________________--____._______-_. ❑ Distance to nearest lot line----------------------/---------------------------------------------- ------------------------------------------------------------- Remodeling and/or repairing (describe): _,f__,_--___,-�f.L►fwl' / 1* ----------------------- 4,4 ------ . ■ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- I hereby rtify that I have pr this application and that the work will be done in accordance with San Joaquin County ordinances tae laws, and rules a d egulations of t e San Joaquin Local Health District. (Signed)-. ----------------------------------------------------------------(Owner and/or Contractor) (Pi(By: I---------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------------- Pl ,, 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 ---1i;! --i4i! ------------------------------- REVIEWEDBY--------------------------------------------------------------------------------------------------------------------- ------ DATE...--------------------------------------------------------- BUILDINGPERMIT ISSUED ----------------------------------------------------------------------- ------------------------------ DATE-------------- ----•--- ------------------------------------- Alterations and/or recommendations---------------------------------•--------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ---------------------------------- }--- FINAL INSPECTION BY: /------------------ Date, -.60 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 ES -9-2M Revised 8-'59 F.P.Co.