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APPLICATION FOR SANITATION PERMIT Permif 1�0. .-•---... . .. .. (Complete in Duplicate) d This Permit Expires 1 Year FromDateIssued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and i stall the work herein described. This application is made in compliance with County Ordinance No. 549. � � JOB ADDRESS AND OCATION- . • --- ............................................. •-------- - ----•-. .._. ...._'.. ...... _:. ...... ....... Owner's Name- - �p ------x- ✓4----'--'--••'- ------•---- --•----- ----------- ----- - --------- --------- --------- Phone.................................... Address------(>o w-- --c["' .............� Contractor's Name.- _3_ - - _ - •--------_---- ----- --•--- Phone................................... Installation will serve: Residence r" Apartment House ❑ Commercial ❑ Trailer,Court ❑ Motel ❑ Other ❑ Number of living units: J.... Number of bedrooms .. Number of baths 1X__'Lot size -__ .....•............. Water Supply: Public system ❑ Community system ❑ Private] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑, No X New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2(0 feet) Septic Tank: Distance"from nearest well ++Dista fro n an No. of compartments.......�•..............Size � Liquid depth___---4-------- -------- Ca acity. _ ...-_ Disposal Field: Distance from nearest well 5O------Distance from foundation... e d. Distance to nearest lot line Number of lines..s 7�.___ Length of each line_ -'---.Width Width of trench *# Type of filter materi �i Depth of filter material..__.f �_--------- length-. .......-..., , --- Seepage Pit: Distance to nearest w I. ..................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 0 Size: Diameter----------------- Depth ._...- __-------------Liquid Capacity Privy: Distance from nearest well------------------------ _____ ______-___Distance from nearest building------ .............._....__., ❑ "Distance to nearest lot line--------------------------------------------------------------------------------_--..... ---..._ .. -• •-----. Remodeling and/or "repairing (describe):----__--------- ---------•- ---- - ----------••-----• ---•-- ---------•• •---- -------- -- ..... . ._., --------------I-_------ ----•--- ...-------------------------- -- - ------ ----- - ------ ------- ----- ----- --------- ---- - ----- . I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin. ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. (Signed) -'t� ft -------- . _}.._ (Owner and/or Contract-04 " By:.......................................................... ....: ------ --- ---- Tit ) •l le---- ..... -r - ----•. -- T r (Plot plan. showing size of lot, locati 4f system inrelation to;walls, builal ,,ate.*cen be phce4 on`revers+e stele}: FOR DEPARTMENT USE ONLY 00 APPLICATION ACCEPTED BY ......................................................... DATE Q--.................... ................................. •---•------- ••--- -•--•-. REVIEWEDBY------------ ----------------------------- ---- -•`------ ---------- ------- - ..... DATE.........................................-............... BUILDINGPERMIT ISSUED............................................................... -----••-----•-------- ....... DATE. Alterations and/or recommendations:------------------------------------------------------------------------- ------- ---- •-------- -------- - ------ ------_ •-------- FINAL INSPECTION $Y:.. _.. Datel-. ..... ........6C7----------------------------------------------------- SAN ------- -------- -------- --------- 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•9-21A Revised 8-'59 F.P.Co.