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APPLICATION FOR SANITATION PERMIT Permit No. �. (Complete in Duplicate) y Date Issued .---/_ 'Q-..- 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. i JOB ADDRESS AND LOCA N___ -----Y-- - Owner's Name-------2iL Address----------1 ' -----•-------------------• -------------•---------------------------•---- i Contractor's Name .-- +' �..�_ -------- Phone------•-------------•------------- I - -------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: ---I--- Number of bedrooms __ - Number of baths __/---- Lot size _� -_. -.�Of_•�__ _______________•_ Water Supply: Public system 59.,Community system ❑ Private ❑ Depth to Water Table,I_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZHardpan ❑ Previous Application Made: Yes ❑ No W4.4_New Construction: Yes J4__�to ❑ FHA/VA: Yes ❑ 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---��Distance from foundation----�4-.........Material---G-G c�Ac %L. No. of compartments----�-------------Size__4,,6_Ze-X__Z-G_Liquid depth----A_D------------Capacity----!9-tJ-------- Disposal Field: Distance from nearest weli_..V stance from foundation,_-/--$--/-.-_.Distance to nearest lot YPof filter material--- � lines:;d_ _"_, [ - Number of lines-------I-------- Length of each line-----,�- - __-Width of trench- '� Type _ -. _ . —epth of filter materialIt-__./�__ ---Total length------�,6__---------_--__._______ I Seepage Pit: Distance to nearest well_- _Distance from fou-nd�!ttion____'�Q_.___ Distance to nearest lot line-----10:�-__ [ Number of pits_./-------------_.Lining material-�19441a ze: Diameter------- Depth_...-n2._,&—--------_ -- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material-_------. ❑ Size: Diameter------------------------ ------------ Depth ---------------------Liquid t 0 ----gels. Privy: Distance from nearest well----1--------------________-.-_-----------------Distance from nearest building------------------------------ ❑ Distance to nearest lot Gne--------..____________________ Remodeling and/or repairing {describe)------- -------------------------------------------•----------•---------------------------------------------•------- - --------------------------•----------------------------------------------------------------•-------------------•--------------------------------------------- ----------------- -------------------I--------------------------- --------------------------------------•------•--------------------------------------------------------------------------------•-------=------------------------ ---- , I I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e I s, and rules and regulations of the San Joaquin Local Health District. (Signed)----__. (Owner and/or Contract ) -- ---- -- ---------- ----- -=- -- $ ; ------------------------------- Title...... -J --,� or (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-._',f ------------------- REVIEWED BY-----------------------------------------=--- ------ ---------- ------------------------- - ------------------------------ DATE BUILDING PERMIT ISS6 6-...--_-------------- - DATE. Alterations and/or ecommen ations.t-- _ __._ �:--__- _ r ----•------•• -. . FINAL INSPECTION BY:...... ret- - ----------------------------------- 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 E5-9-2M , Revised 1-57 F.P.CO. �, $