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r fi .✓ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described_ This application is made in compliance with County Ordinance No. 549, JOBADDRESS AND O ATION----------9-r'0-!--------0- ---- --------- ------------------------------------------------------------------------------------------------- Owner's Name---------_. O---_------ -----------------------•----- - ---------------- ----- ----------------------- --- -------- Phone----------------•----------•-------- Address------------- f _ Contractor's Name ------------------------------------------•------- - ----- Phone_ - ! - la Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ .T Other ❑ Number of living units: ___/__ Number of bedrooms__ Number of baths _ _____ Lot size ____--_ __ Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table _'/ ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool permitted ifublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well 4 �___Distance f kom fount anon__. 0__- Material---- - ----------------------------------. E No. of compartments_.I___a---------------Size.__ �i-_-1 .5 -------Liquid d __ epth___ _ Ca acit _ A_D_p_______ Disposal Feld: Distance from nearest weEi�-._Distance from foundation__��_______+Distance to nearest lot lines__vim ______ Number of lines--------- ----------------J----Length of each line------1.0A_ __SV_.Wic1th of trench---_e�:��_____.___________-- Type of filter material-1 Depth of filter material-- 10- Totallength------ -`5 ------------------------ Seepage it: Distance to nearest well''-___Distance from foundation--_1 ......Distance to nearest lot line--_ Number of pits...., ____'._______Lining material__ 4:GIt___-.-Size: Diameter._.___-a_.�.-._...___.Depth__.. J_�____.-_____-.___ 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 dine-------------------------- --------r----------------------------------- ---------•------------------- ------------------------------- - i Remodeling and/or repairing (describe):----I�-----------------------------------------------------------------------------I'll------..----------------- i --------------------------------------------------------------------------------------------------------------------------- --- --------------------------------------------------------------- r ------------------------------------------------------------------------------•------------------------------••-------•----------------------•---------------------------- --------------------------------- -------------------------------------------------------------•-----------'•----•-•--------------------------•------•--------•-•------•------•----•---------------------------•--------------------------------------- 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} ! •- --- ----------- (Owner and/or Contractor} j By:-- ----------------- ! ------ ---- --------------------------------------------------(Title)----- -----z----------------- ........ ---------- (Plot plan, showing size of lot, loot tion of sys in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- =------ ---------------------------------- DATE--------- --------------------------- REVIEWED BY------------------------------------------- DATE BUILDING PERMIT ISSUED-----•-------------------------------------- DA•TE------------------------------ - Alterations and/or recommendations:----------h-----------------------------------------------------------------------•---------•-•-•---------------------------- ------------•------------- ? - I? ------------- --------------------------- -------------------------------------------------------------------------------------------------------------------------•---------------------------------...._---------- PT"F-�S------- f `� 4 `r =o.--------t_t=z7 --------•--------------------------------------- •------------------------------------ -------- �- ------- -------------------------------------•--• ------------- I. -------------------------------------------------- - ---- - ------------------ - - ---- - ------- -------------------------------------------------------------------------- il �! FINAL INSPECTI BY: Date._- 1'��" ✓,l-------------------- 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 1 ES-92M Revised 8-'59 F,P.Co. - .a ��