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APPLICATION FOR SANITATION PERMIT Permit No. ...1�. �� ' (Complete in Duplicate) 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. � �'JOB ADDRESS AND LOCATION2 - /_� Owner's Name---- f------ ------------------ -------------------------------------------- PhonA..'----��j O Address...............'2 3.0... ... ........•`. Contractor's Name--•- ---------••-•--------------------•---•------ -------------------------------------------------- Phone...........-----------_---------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _- _____ Number of bedrooms _____-_ Number of baths a� Lot sizel�•- ------------------------------------ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table i`.'. . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam) Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes In No ❑ 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/.e10-------Distance from foundation----1 -------- Material---- ------------------------------ ;0 No. of compartments----oL------------------Size__�_t_f_1"_r.___Liquid depth-----Al-----------------Capacity.,l_.2-o- -------- Disposal Field: Distance from nearest well..l.s3d._'.__Distance from foundation....!a .. Distance to nearest lot line..4 ......... p ' Number of lines .2— Length of each line______?�'_��_______-_.Width of trench__�_f-_---_•_--_-._-__-__----- Type of filter material i4�. , W.Depth of filter material__Af______________Total length---16a___--__.__-_____.______•.___. �1 Seepage Pit: Distance to nearest we`ll_ ---------------Distance from foundation....................Distance to nearest lot line---------------- ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Dept h__-_-_.--.-_-_--_--•____-__..__-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---__--____-_---._-.-__•--.-____-•---. ❑ Size: Diameter--------------------------------------Depth-----------------•--------------------------------•-Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El ---_---_--___.-_---_•-•-•__.__-___-__.-.❑ Distance to nearest lot line------------------------------------------------------------------ ------------•------------•--------••----- -------------------------- Remodeling and/or repairing (describe) ---------------------------------------------------------------------------------------------------------------_---------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify thfhnavpared this application and that the work will be done in accordance with San Joaquin County ordinanc e , egulations of the San Joaquin Local Health District. (Signed) -------------------------------------------------------(Owner and/or Contractor) By:------------- • ------------------------- --------------- -----------------------------------------(Title)------------------------------------ --- - ---- --- -(Plot plan, showin a of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- - ---------------------------------------------------------- DATE----`�''.2-r!1.0----------•------------------ REVIEWEDBY-------------------------------------------------------------------------------------------------------------------- -------- DATE------- ------------•-------------------------•------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE-----------_-------------------•------------------------- Alterationsand/or recommendations---------------------------------------------- ------------------------------------------------------------------------------------------------------........ --------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------•--------••---- ---------•-•---------------------------------------------------------•- --.--.-------------------------------------------------------------------•---------------------------•-----.----------------------- ---------- ----------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- -------------- ------------------- -------------------------------------------------------- -------------------------------------- -------------------------------------------------•----------------------------------•---------------------------------------- FINAL INSPECTION BY:. �iT----------------------- Date- _. � �' � 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.