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i /tea A37- +� h 3` � APPLICATION FOR SANITATION PERMIT Permit No. ........................ G U" (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ... .,7 p 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 LOCATION / c �... -------------------------------- Owner's Name----------------- tet/.-..... `. - .-+� jZ------------------------------- --------------------------------------- Phone.................................... Address '` ` ------------------------------------------------------- --- --- Contractor's Name---------------------------------•--•-------------� /-----�-- -•---- Phone i� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ . Number of bedrooms _ _ Number of baths __ __ Lot size ___ ___________________________-_ Water Supply: Public system 113--c-ommunity system ❑ Private ❑ Depth to Water Table '��_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [5--New Construction: Yes ❑ No ©--FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.4 ) annkk' Distance from nearest well________________Distance from foundation--------------------Material______--________:___--_:_._--__-______:'-- 4� No. of compartments--------------------------Size................................Liquid depth--------------------------Capacity........................ ispo I Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. Number of lines__________________________________Length of each line------------------------------Width of french------------------------.__-____-__ Type of filter material_____ _________________Depth of filter material-----------------------Total length-_______________-:_--_-._-____________--__ 0 .- i Seepage Pit: Distance to nearest well _.__ '__-Distance m fQ�undation__/.r_....___.Distance to nearest lot line.. ��.._.. [t Number of pits_______f___.-_____Lining material_ < ___Size: Diameter______2�-3__� ____Depth_____. 3!_!-__._-_____. Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material-------------------------------------- G11 ❑ Size: Diameter--------------------------------------Depth----------------•----------•---- -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------._._:_______._. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------•------•------------•----------------- Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------------------•-------------------•- ----------------------------------------------------------------- ------------------------------------------------------------------------------...------------•------------------------------------------------------- ------------------------------------ ----- --------------------------------------------------------------•----------------------------------------------------------------------------------------------------------------- I herebyc 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- 4� --- ` 4--------------------- - -------------------------------------- (Owner and/or Contractor) By:------------------------------------------------ �'� -�----------------------------------(Title)-------------- ---r--------------------- -------- ---- -------- (Plot plan, showing size of lot, location of system in relati o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -¢ _------------------ DATE <' _____. REVIEWEDBY----------------------------------------,'' �---- - -- ----- ---------------------------------------------.. DATE -------- --------- -------------------- ----- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------------------------=--------------- Alterations and/or recommendations--------------------------- ----------------------------------------------------------------------------------•-------------------------------------.._-------- ----------------------------------------- -------------- G�� Cv -------- I fie--••-- ------ ----------•-•-----------------------•-----------•----•--- '- �/` FINAL INSPECTION BY:._ -_ ___ ______ _ _ _ __ _________ Date------------- __Q _ - SAN JOAQUIN LOCAL HEALTH DISTRIC 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.