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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3` Date Issued This Permit Expires 1 Year From Date Issuod Application is hereby made to the San Joaquin Local Health District for 0 permit to construct and install the work herein described. This application is made in compliance,-with County Ordinance No. 549. /� `'l p JOB ADDRESS AND LOCATION..._d �lr - ' � j�� r �-, - Owner's Name. ,raj s, ..._ . ra •----- ----'!""t,....--- -----. Phone.................................... Address Contractor'sName..10!,.201"06�------------------------•• •. •-- .......................... Phone ........ -----••... ---•-. Installation will serve: Residence,29 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel O� Other ❑ Number of living units: ...I---- Number of bedrooms -_2,,.. Number of baths J.....-Lot size .+ ............................. Water Supply: Public system ❑ Community system ❑ Private JN Depth to Water Table 479- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe❑ Hardpan.❑ Previous Application Made: Yes ❑ No,R ; New Construction: Yes No ❑ FHA/VA: Yes ❑ No❑ iNSTALLATlOt4 Ab1&SPEC1Ff ATIONh: (No septic tank or cesspool permitted if public sewer is available within 200-feet.) Septic Tank: Distance from nearest well Distant' from foundation---- 0 ____.M terialhr $ize� Liquid de th_..T .-------------- Capacity..' a aci ty ' !No. of compartments___..__ -.-------- Disposal !t.� Field: Distance from nearest.well . .Distance from foundation �� Distance to nearest lot line r. Number of lines_ -�...._ _Length of each line--_�{�—` Width of trench c3.'. Type of filter materia Depth of filter material I.. ' Total length-=_/.14� -- x Seepage Pit: Distance to nearest we I __.....Distance from foundation ..__... ...Distance to nearest lot line IJ Number of pits......................Lining material•-._ .__--__.____-Size. Diameter....__........................Depth................................. Cesspool: Distance from nearest well Distance from foundation.---_.---------------- Lining material. ............... nSize: Diameter-- -------- --Depth---- -------- -------------------------------Liquid Capacity ----••. -••--=.......gals. Q--- Privy: Distance from nearest well__________________ ___-_--._ ___-____--_--Distance from nearest building----............................ ..__. �y ❑ Distance to nearest lot line--------------•---•- ----- •_.•.-- ---- ----- ------- -•- -------- -•-x ......... ......-.. -' Remodeling and/or repairing (describe):---- -•--_-----------_------- ----•--• •-•-•-•• •---•••. •-••--•--•••......-• -•----------------•- ---------------••• ••----. --•-•-• -•------ ---•-•• -----------------------------------------------------------------------•----••----•-•-•••--- ----- • . •. .. .. ---•------- .-_ ountoI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County-- ordinances, rdinances, State laws and rules, regulations of the San Joaquin Local Health District. S' n 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....V?�.....V...4�O---------------------------------- REVIEWED -------• --- --------_-•----- REVIEWEDBY--------- ---- --- •----••-----•-- ---•-..... DATE........................................................... BUILDINGPERMIT ISSUED...........................................•-•---• ---•--......................................... DATE........................................................ Alterations and/or recommendations ..... ..... ...•--. ----- ----- ......--- ... --_. . _.......•... ... • ...... ---..... ......-- ......--- . ..-- FINAL INSPECTION BY:.- -_--------_---- Date.........................................0 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 €5-9-2M Revised 8-'59 f.P.Co.