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x f , APPLICATION FOR SANITATION PERMIT Permit No...�1..' 4 (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 Inst 11 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--____ --------------- -------------------------- -- ------ Owner's Name ----".0t ----------------------------- ----------------- -------------------------------------- Phone ----------------------------------- 2 #001 -ft AV, * Address---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i - I Contractor's Name _. " --� ---- "11 i - ------------------------------------------- Phone ......... ................. Installation will serve: Residence [S Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____._ Number of bedrooms$!_____ Number of baths I ----- Lot size ---=_ r _____________________________-__ Water Supply: Public system ❑ Community system ',M Private ❑ Depth to Water Table :rE?- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe t Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes I No ❑ FHA/VA: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well from foundatiLn Material ------------------- No. of compartments ------------ . __Distance Sae..__ ---- --qdepth=--- Capacity --- ----C--- ----- Disposal Field: ' Distance from nearest well ..-Distance from foundation A -- Distance to nearest lot line * .C, Number of lines_ ---------- __ Length of each line_.___ --------------- Width of trench _----------------------- __.._ ___ .._-_Type Typeof filter material___:__`Depth of filter material ___ ._ _Total length .�s�"________________________:. Seepage Pit: Distance to nearest well------ - :' ___-_____Distance from foundation---- ---------- Distance to nearest lot line_. _____._- Number of pits-_ . :___________ Lining material-___-''' _______Size: Diameter.____ ----------- Depth _ _ #.._2 ..... Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining material ____.--___.______-______________-_ ❑ Size: Diameter -------------------------------------- Depth ------ --------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well -------------------------------------------------- from nearest building_. ---- .------- .__-___-____-______-.___._- ❑ Distance to nearest lot line ------ ------------------------------------------------------------------ ---------------------------------------- ---------•---•---------------- --- -- *:__ 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 regulations -of, the San Joaquin Local Health District. (Signed)------------------------ --- ----- a4 - 0-04-► I k, ---------- --- ------ - -------- --------(Owner and/or Contractor) -------- Title --------------------------- ---- --------- BY: - --- - (Title) (Plot plan, showing size of lot, location of sy in relatiory to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------------------------------------------. DATE -----•3 lfl -------------------------- REVI EW ED,,.BY-------------------------------------------------- --------------------------------------------------------------------------- DATE ----------- --------------------------- ----------- BUILDINGPERMIT ISSUED ------------------ -------------------------- ----------------------------------------------------- DATE ----------------------------------- ------------------------- Alterations and/or recommendations:----•- ------- ---------------------- ------------------------ ---------- --- _____________________ ______ �___ _.__--------- ___. _:___...._.._..___. _.___ _.. _______.___ ____ _ _.______...__ .... _.._ ____-__.__-__--______--_-_-__-________-_---_--_____ r-- ------------ ---------------------------------------------- . FINAL INSPECTION BY.% -... ------------------------------- Date-- / � f c� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES -9-2M Revised 8-'59 F.P.Co. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California