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APPLICATION FOR SANITATION PERMIT Permit No. ` .`f--- �� (Complete in Duplicate) Date Issued ---- '"` `.°d 10 This Permit Expires 1 Year From Date Issued q Health District for permit to c nstruct fid In[s 11 the work herein described. Application is hereby made to the San Joaquin Local He p I pp e`with Countyl,0rdinance No. 549. This application is made in comp ianc � J 7 � J ` -----------------------------------------"--- JOB ADDRESS AND LOCATION-=------------- - Owner's Name------------ ------------------------ ----- Phone. Address---------••------------� -- ---------------•----------••--------------------- aa Q� ---------------- Phone. _�,P1 Contractor's Name----------- ------------------- - - -- ---------------------------- - Installation will serve: Residence El--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` ,�_ Number of baths ----- Lot size .49 ----------- ------------- --- Number of living units: .___---- Number of bedrooms __ Water supply: Public system �--Community system;❑ Private F-1Depthto Water Table �d ft. Character of soil to a depth of 3 feet Sand ❑ Gravel,❑ , Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M--Hardpan ❑ l Previous Application Made: Yes [I No [k,�'New Construction: Yes ❑ No FHA/VA: Yes ❑ No [LJ— TYPE LJ TYPE OF INSTALLATION -AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r Septic Tank: Distance from nearest•well--_____._.__?___Distance from foundation_�"$---_------Material....- __ - •--------------- - i �'�`�x Li uid de th__.. -------Capacity- o No. of compartments__-----------------Size--.._... _. - q gyp• --------- Disposal Field: Distance from nearest,weii._.__'"�'-._-."Distance from foundation""" Q""---------Distance to nearest lot line__ ___--""_" �{ Number of lines---------- -=------------- -f--Length of each line-------�8_�----- - Width of trench--------91-*_-------------- yp aterial____.KQCf-------'Depth of filter material_ / ffotal length---------`= a--•- Seepage Pit: Distance f tonearestwell_____'~ Distance from foundation--/AQ--------- ------.Distance to nearest lot line_-. _-""--.- __"_Linin m / �. � Number of pits--�---=-�------ g aterial�rt�`�'--- ----Size: Diameter l/-rX- --"- -----Depth------ ------------------------ Cesspool: Distance fiom nearest well-__ .____ :Distance from foundation. --------- -------- material---- -------------- .gals. ❑ Size: Diameter--------------------------- ---------Depth----------------- - -------=---- ---------------------Liquid Capacity ---------------------- -g Privy: Distance from nearest well.___.__- -"-_------- "---------------------Distance from nearest building____....___------------------------------- ❑ to nearest lot line---------------- ------------ ----------------------------------- ----------------------------------- Distance� f I rye- f _______________________________ Remodeling and/or repairing (describe):_---_._;_----------------------------------•-- . -------------------- ----•-------------------------------------------------------------------------- i - - ,_ -- ' .___.-_"_____________________________...____ j 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 r s rid,regulations of +he San Joaquin Local Health District. „r -------------------------------------(Owner and/or Contractor) ----- t (Signed) Titl ------- - --------"------ --- --------( ) "" e (Plot plan, showing size of lot, location of.system in relation to w"Ils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY O. DATE------ ` / ---------- 1 APPLICATION ACCEPTED BY_-- _ _.�. '-- DATE------".---------------• REVIEWEDBY-------------------------------- -------------------------------------------------------- ---------------------- BUILDING PERMIT ISSUED - - ------------------------- DATE------------------------------------------------------ ---- Alterations and/or recommendation ss:__----__--------------------------------------- - 1 --------- -- ------- ---"------•-------------------------- ------------------------ I ------------------ ------------------------------•--- --- ----------------------- ---•.---- FINAL INSPECTION BY• ..._._ -----""---- ------------- -- Date- --------------------------------- Ziol- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street 1 Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M Revised 8-'59 F.P.Co. _