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APPLICATION FOR SANITATION PERMIT Permit No. ...... 10N\ (Complete in Duplicate) / Y� 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 ANDLOCATION........ F ------ - -- ------- ------ -------- - ----------------------------------------.------------ S�,,L^^ _. _� -. Owner's Name---------- C1. a------- o ------------------------ ------------------------------------------- Phone-----------------------............ Address........................ - a � _ a7 SContractor's Name . £ ---... Phone Installation will serve: Residence Artment House ❑ Commercial ❑ Tr iter Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms 4;7-. Number of baths _/__ Lot size ---------------------___________________ -------------------- Water Supply: Public system ❑ Community system ❑ Private I" Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam;r Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0 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 200 feet.) Septic Tank: Distance from nearest welL__,�rO____.Distance from foundation.... ._0---------Material________ ___ _ -_____-___. ( No. of compartments------._.__.-___--_Size �Z.___X._9___ -_Liquid //depth----f __....______Capacity_.�_,2-:0.0_. Disposal Field: Distance from nearest well___�T ___._Distance from foundation....1�_...-----Distance to nearest lot line...J�......... Number of lines-__._______-________________ Length of each line.__-___-_fv_t2____��__-_.Width of trench-____ ------------------------ Type --_________________--__ Type of filter material__!'--___Depth of filter material------fJ__ ---._Total length..../.�f2---------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation____-_-.-_------__-.Distance to nearest lot line-----------_---- ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter_____________________Depth---------.__-_.__.--____.------ ``j' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------.---------.............. r ❑ Size: Diameter-------------------------------------Depth.--------------•--------------------- ------Liquid Capacity-.-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------.___._-_____. ❑ Distance to nearest lot line---------------------------------------------------------------------------•-----------------------------•----------------------------------- Remodelingand/or repairing (describe):--------------------- ------------------------•-----------•-----------------------------------------------•------------•------------•--............... ------•------------------------•----------------.-.------------------•--------------------------------------------•--------------•----------------------------- ------------------------------------------------------------- --------------------------------------------------------------------•-------------------------------------------------------------•-•-----------------------------------------------------•--------------------------------- ---------------------------------------------------------------------------------•--------------------------------•-------------------------------------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. (Signed)_ ) ---------------------------------------------- Contractor e�; S 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� ,p APPLICATION ACCEPTED BY � ---------------- ---------------------------------------- DATE--- �96------------------------------------ REVIEWEDBY----------------------------------------------------------------------------------------------------------------- -•-•-- DATE--------------------------------------•--------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------------------------------------------•-------------- • --------------------------------------------------------------------------- -----------------------------------------------•------------------------------------------------------------------------------- ---------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------•-------------- --------------------------------------------------------------------------------------- ------------- ----------------------- ----------------------------------------------------------------------------- ----------------------------------------- --------------------------------------------------------------- ,16 -6o FINAL INSPECTION BY:. --------------- 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.