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"4 APPLICATION FOR SANITATION PERMIT Permit No. ..././...� ... v ( / !) � (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ? (F_�___ 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. JOB ADDRESS AND L CATION_______ ®_ -S -------- --- - - - - ------- Owner's Name-------------- •- -----•" ---------- ------------------------------------------------------------------------------------ -- --------------------- Phone--------------------•-----------•-- Address .� � � - Contractor's Name_______________________________ Q 4-k-------------------------------- ------------------------------- Phone Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____/ Number of bedrooms -_f--- Number of baths --/-- Lot size -------,$7z_ _ - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3—Hardpan ❑ Previous Application Made: Yes ❑ No 0--• New Construction: Yes ❑ No [c]--FHA/VA: Yes El No F-1TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well_________________Distance from foundation-----------------------------.Material------------------------------------------------� No. of compartments--------------------------Size----------------------•--------Liquid depth_-------•------- Capacity--------------------- D' osa Field: Distance from nearest well__-___-__-"____"_Distance from foundation....................Distance to nearest lot line............ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------- Type of filter material____________________"_ Depth of filter material_________ Total length----------------- ....................;Pit: Distance to nearest welly, Q/ / /!� - Distance-fpm oundation__ Q-____"_.Distan��e to nearest lot line---,l Number of pits_____/-_-________ Linin matenaL ' g - ------ ------Size: Diameter 3 i3------------Depth----R $ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__-_"__-_______-______-_____-___ r ❑ Size: Diameter----"--------------------------------Depth------------------ ---------------"-Liquid Capacity----------------------------gals. Y Distance from nearest well___ _Distance from nearest buildin Distance to nearest lot line g Remodeling and/or repairing (describe):---------------------------- -------------------------------------------------------------------------------------------------- ---------------------------- I hereb ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , St to ws, and rules and regulations of the San Joaquin Local Health District, (Signed)---- ----------- - ---._--J-"___ (Owner and/or Contractor) ------ ------ BY: -----•------------------•--•----- ............ -- -- ------------- - - --- -------(Title)--------- - (Plot plan, showing size of lot, location of sys+em in relation to a s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-____.___"_______-_:__ "___ ---- -------------------------- DATE----------------- ------ ---------- REVIEWED BY___ _ " " DATE---------9•--"- f BUILDING PERMIT ISSUED------------------ _ ---------------- ------------------------------------------ DATE Alt rati ns and/or recommendations: ______ --- •--- - - ----- -- - c' = = _ ----------------- ----- ------ _ _ o ----- ----- '� - 1Q�QP. 1 j�iv 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.