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APPLICATION FOR SANITATION PERMIT Permit No. ...,� ..7_�j �-� ( � (Complete in Duplicate) 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 des fed. This appl'c 'on 's,mac�q in ante . h County Ordinance No. 549. 7�� Gt'°aL. JOB AD RESS�A D CATION-_ %---------------- -' � o Owner's Name � - - -- ---- ------ ---- ------ Phone----------------------_------•--- Address ------ �' - ---- a Contractor's Name--------------------------------------------071.10--- ------------------------------------------------------------------- Phone----------------•------------------ Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J.___ Number of bedrooms _'___- Number of bathsP'___'_ Lot size"___ __ .d________________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _7-___ ft. Character of soil to a depth of 3 feet: Sand T'_Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Z'�' 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.) r — Septic Tank: Distance from nearest well -x►�r_,Distance from founda,�'Qn__1�(1___ Material___C .f________________________ No. of compartments------2-__-___ .____rSize.._ ,X_ _,__.Liquid depths_____'f______________Capacity../2. 40_-a�'__... 01 If Disposal Field: Distance from nearest well___ from foundation.,/,&'?I Distance to nearest lot Number of lines.._.___.z__----_____ _______ Length of each line--& _t___ 'Z__.Width of trench.___:Z __`_�__ Type of filter material ,. AAAA/Depth of filter material____- length........1_ -O ________________•- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----_._____..__-- J ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth___.__-__.__________..__.-___-__- 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_______________________---________-____. v` ❑ Distance to nearest lot line-------------------------------------------------------------------------------••-----------------------•-------- -------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------ ------------ -----------------------------------_............................. (� ---------------------------------------------------------•---------------------------------------------------------------------------=------------------------------------------•-•-•-------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------- =.---------------------------------------------------------------------------------- 4� ------------------------------------ ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. �f ----------------------------------------------------------- Owner and/or Contractor (Signed)--- ?4,wi-------- -- --- :: l / ) By - ----------------------------------------------------- ----------------�- ----------------------------------------(Title)------------------------------------------------- ------------ (Plot plan, showing size of,lot, location of system in relation to'N ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - ------------------------------------------------------ DATE----140- -0----------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------'--------------- DATE------------------------------------------------------_-- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------ ------------------ -----------------------------------------------------------------------------------------------------------•- ------------------------------------------------------- ----------------------------------------------------------------------------------------- --- -----------•-------•--•--......-------------•-------•--------•--------- ------------------------------------------------------•----------------------------------------------------------------------------•----•--••-----•-•-•--...------------------------•-----------._.........--------------•-- ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------- ----------------------------------- ------ 1 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.