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V APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance w h Co my Ordinance No. 549. / / JOB ADDRESS AND LOCATION ............i -�_)-�---- j___S/4Cc Owner's Na - __________________ Pone_ Address--------------------------------------3l plc - �..�, ---------------------------------------------- Contractor's Name---------------------------------------- -=--••----•---------•----------------------------------------------------------- Phone-------------------------•-------- Installation will serve: Residence iQ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __---- Number of bedrooms -_ Number of baths 'a.2--Lot size ---------------------------------19�-1319___________________-- Water Supply: Public system ,20 Community system )q Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clays' Adobe,®' Hardpan ❑ Previous Applicatioq, Made: Yes K No ❑ New Construction: Yes jK No ❑ FHA/VA: Yeses No ❑ TYPE OF INSTALLATI&I-AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 4,z Septic Tank: Distance from nearest well___` -____Distance fro fou da tion____��?c_._____.Material__._______________________ _.____ No. of compartments_--__ _� _____. __Size____________ ._.f�quid d'e th __ ____________Ca acit ZZQ spa' � P P Y 9------------- Distance --- Disposal Field: ' Distance from nearest well _Distance—from fAl anon..._lQ__.Distance to nearest lot line,__�_ _ of lines-------�10----- - __-__Length of each line______-- - of trench------------ Number :r C� Type of filter material. ---------------Depth of filter material---------Jd---------Total length------------------- :---- - � W Seepage Pit: Distance to nearest well ______ ___-___Distance f m foundation ...LQ..........Distance to nearest lot line---------------- Size: _. __- � Number of its----_ °` `' i r p` ______ Lining material_____`_ ------- Cesspool: l _._-Size: Diameter--':Z-1 __ ____Depth------l 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 - Repd i and/or eairing ( scribe : -------------------------- &p _ --- _ _- , C_z, ---- = - ------• -- ii - �- ---------�-�==------- ------ - ------------------- - ------ I hereby,ce fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, $tate laws, and rules and rejoulations of the San Joaquin Local Health District. (Signed) ..—--------------- ---------- ---------------------------------------------------------------(Owner and/or Contractor) 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 APPLICATION ACCEPTED BY------ - DATE------ REVIEWED BY----------------------------------,{- -------- '' (/ - - ------------------------------ ----.. DATE BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------ DATE--------------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------•------------------------------------------------ ----------------------•---------------------------- ------------------ ----------- ------------------------------------------------------------------------- ---------------------------- FINAL INSPECTIO BY:. -- ------------ �' _'=j ----- 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 r" ES-9-2M Revised 1-57 F.P.CO.