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APPLICATION FOR SANITATION PERMIT Permit No. ..1 . .� (Complete in Duplicate)( P Date Issued __11 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. _ _. c JOB ADDRESS AND LOCA N._.__�t____ _ tt`� .n�...P t Phone..................................... Owner's Name. -""�" - ----- -- ---- ----------,Z/ Address------------ -.4A -.....3 �""---- --------- --••-------- Phone Contractor's Name................................................. -------------------------------------------------_ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1..... Number of bedrooms __-3-. Number of baths _2-__ Lot size __7.5__--,X____ .- - ------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -A--- ft. Character of soil to a depth of 3 feet: Sand Gravel F1 Sandy Loam 171 Clay Loam [I Clay C] Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No [�K New Construction: Yes Er"'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: • c sewer is available within 200 feet (No septic tank or cesspool permitted if public Septic Tank: Distance from nearest well..-,>'� ----- is.ance from found,�inn__lt_'3'!�'' 1GfateriaL.--� - _ "%e"�d-------------- Sep -a, No. of compartments--------tl-------------Size--- ---Liquid depth-,----- ------------Capacity--- °- Disposal Field: Distance from nearest well-5 stance from foundation.-1�-I%t*,"''f�rstance to nearest lot Number of lines------Z -Length of each line---��---- -- Width of trench.__. .. Type of filter material.__3 __ _ __ ___Depth of filter material_____,l-!s ____Total length_-_______t� _________________ Seepage Pit: Distance to nearest well _____________--------Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits--------------- ------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material-----------------------._.__-_-__-•-. Y ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--•-_------------•--------gals. Privy- Distance from nearest well-------------------------_------_----------------Distance from nearest building----------------------_-•-___.___.______.. ❑ Distance to nearest lot line--------------------------------------------- ---_---------------------------------------------------------------------------------------- Remodeling -- -----------Remodeling and/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 laws, and rules and regulation of the San Joaquin Local Health District. ------(Owner and/or Contractor) (Signed)---------- -- - P • -- ------------------------------------------------------------------- (Title) - --------------------------------------- --------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). AR ENT USE NLY APPLICATION ACCEPTED BY. �.. ` : ._------ DATE-----f 3' -- ------------------------------ REVIEWEDBY-------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------- -----------------_--- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------- ---•-------•••---- --------------------------------------------------------------- ----- ---------------------------------s--- ------------------------------------------------------------- ---------------------------------------------- --------- ------- ------------------- ------ TION BY:..-----_------------�-- U ---------- { �/ --- FINAL INSPECTION -------------- -------- --- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.