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i -5APPLICATION FOR SANITATION PERMIT Permit No. ..�� ..- ... (Complete in Duplicate) '-�/� Date Issued __./-.'_ This Permit Expires 1 Year From Date Issued x-210 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 Ordina a No. 549. JOB ADDRESS AND LOCATION..........2 4- --------------- --------------------------------------------------------------------------- Owner's Name--------------a_ � � ---- Phone ----------------------------•--------------------------- Address------------•---------------- ----------------: -----------------------------------------------------------` i -- -�-•--•-------------- Contractor's Name........................................................ ---------------------------------------------_. Phone,*dz f---1060/ Installation will serve: Residence 231"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__ Number of bedrooms ._Z Number of baths _/_ Lot size _ _. _l ------------------------- Water Supply: Public system �90`tommunity system ❑ Private ❑ Depth to Water Table 0_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E'14ardpan ❑ Previous Application Made: Yes ❑ No [P/New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) c� Distance from nearest well_________________Distance from foundation____-__..._-_______-Material------------------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth----- --------------------Capacity------_---•--�/ Disposal F7',el - Distance from nearest well?40_X Distance from foundation..___•--__--Distance to nearest lot line„ _-.--_. ®� Number of lines----------- ____ _______ Length of each line..__!____p_--�--rt_..Width of trench.__�_�_______Z....... . Type of filter material----�tc.�epth of filter material....../0_--------Total length---------------------�---_-------- Seepage .it: Distance to nearest wel Distance fo dationQ ' .Distanc��to nearest lot line / W Number of pits___./___________Lining material._ ize: Diameter____33---_-__ --------------- Igloo Cesspool: Distance from nearest well----------------_Distance from foundation_-----------------Lining material--------------._____________________-. ❑ Size: Diameter-----------•--------------------------Depth---------------------------j--------------------=---Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well------_------------------------------------------Distance from nearest building___-________________-___-----_____.-_____. ❑ Distance to nearest lot line----------------------------------------------------------------------•=---------•---•----•-----------------------------•-•--•---- a Remodeling and/or repairing (describe):----------------------------------------------------------•----------------•----------_-.---------------•--•---- •-----------•------------ \ --------------------------•---------------•-------------------------•------------------•--•--•----•-•----------------------------•-------•------•---•---------------------------.-----------•--------------------------------- --------------------------------------------------------•--------------_---------------•------------------_------------------------------------------_-------------------------------------.----------------•---------------- I hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aw , and rules id regulations of the San Joaquin Local Health District. --------- --- caner and/or Contractor (Signed) / ) By=---------------------------------------------------- - ---- -- ------------------------(Title)------ ------------- -- (Plot plan, showing size of lot, location o system in relation to Is, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------4 ------------------------------------------------- DATE--------. -------------------- REVIEWEDBY-------_------------------------------------------------------------------------------------------------------------------- DATE-------------------•------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:----_--------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------- ------------ -- -------------------...----------------------------•---•----------------------------------------------------...---- 1 .---- -- - --- -- - -- - 3..=�--- ---------------------------------------------------------------------------------- ------------------- ------------- --------------------------------- ---}--- ------ - -------- ------ - --------------- 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.