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o _ ._'o 0 APPLICATION FOR SANITATION PERMIT Permit No. .... (Complete in Duplicate) lv & This Permit Expires 1 Year From Date Issued 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 OCATION----- f=5-- � ? J� ------------------------------------------------------------------------------------ Owner's Name----- .......- ------------ - -------------------------------------- ------------------------------------------- Phone.................................... Address--------------------------------- � Contractor's Name_-----------------------�,�..... . �^..� ---------------------------------------------------- Phone_,�A..1 1,4 Installation will serve: Residence�partment House ❑ Commercial ❑ Trailer Co rt El Motel ❑ Other R i Number of living units: -------- Number of bedrooms ________ Number of baths/______ of size Water Supply: Public system Er"Community system ❑ Private ❑ Depth to Water Table '�y 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 ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank; Distance from nearest well_________________Distance from foundation____.--_.______--_--Material_________-____-__--____________.__-_:__________.. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- ie ---------------------- f� L iF ald: Distance from nearest well_________________Distance from foundation-___--.-•_-____-_-_.Distance to nearest lot line................. V, Number of lines___________________________________Length of each line------------------------------Width of trench-------._-______._-__.____-_____-__ a Type of filter material------------------------- Depth of filter material-_____.._-_______-__Total length_____________________-__..______� ep ge Distance to nearest well�Gf '_._-Distanc om ounclation...,fjY_�__.Distance to nearest lot line-_ /S__.._.- - Number of pits_____/-_________Lining materia .___Size: Diameter___ --'_�_____Depth__._r _S'----.-_.______- 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___----_____-_-________________________-_. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------- ------------------------------------------------------- --•-------•----------•-------•----------•-•---.-•---•---------•----------------------•---------•--------------•------------------------------------------------•-------------•------------------------ -------- -----------------------------------------------•-----------•-----•---------------•--------------------------•-------•--------------------------------------•---------------••------------------ ---------------------------------------------------------- -----------•-----------------------------------------------------------------------------------------------------------------•-------------------------------- I herce f that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan s, ate 1, ws, and ules regulations of the San Joaquin Local Health District. • (Signed) -- -- - ---- =--------------- --------------------------------------- ------- Owner and/or Contractor) By:------------------------------------------ (Title)---- ---------- -- ------------ -------------------- ---------9------------------ p ------ - -- (Plot plan, showing size of lot, location of system in relation to we buildin s, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ __1- ----------------------------- Q t] ----------------------------------------------------- DATE.--------- ��----�--/- ---------------------------------- REVIEWED BY----------------------------------------------------------------------------------------------------------------------------- DATE ------------ BUILDING PERMIT ISSUED-------------------------------- --------------------------------------------------------------- DATE---------------------------------- ------------ A terations and/or recommendations----------------------- ------------------------------------------------ -------------------- ---•---------------------------------- -----------------------------------------------------------------------------------------•---------------------- ----------------- ----•---------------------- ---------- --------------- ------ -- --•------------------------------------ FINAL INSPECTION Date------( _,,1-0 ----------------------------- 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 ES-9-2M Revised 8-'59 F.P.Co.