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APPLICATION FOR SANITATION PERMIT Permit No. •-----------------• (Complete in Duplicate) Date Issued ----vkl - - ' CI I 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 Ord* nce No. 549. cPa - ------------------------ -------------------------------------------- JOB ADDRESS AND LOCATION_______ _ _______ __________ ---- ------ ------VU`--------------------- --------------- ------------------- Phone Owner's Name___.- - ------- Address------ ------ -- ------ --------------------------------- Contractor's Name------------ -� -- -- --- -------------------------------- ---------------------------- --- Phoned ` a Installation will serve: Residence [f�Apartment House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ tel. Number of living units: _ ___ Number of bedrooms _ umber of baths __!-_-_ Lot size ___f Water Supply: Public system ❑ Community system rivate Depth to Water Table�a' ft. Character of soil to a depth of 3 feet: Sand E] Gravel [D Sandy Loam El Clay Loam E] Clay El Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2-1 New Construction: Yes ❑ No [�FHA/VA: Yes ❑ No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S is nk� Distance from nearest well-----------------Distance from foundation___-____.-___-_-__.Material___._--_.______________________________________ Liquid depth---------------- ---------Capacity-•----------- No. of compartment-s--------•----------- ----5'sze-------------------------------- _ ' •� r Distance to nearest lot line.-_.4.__---- isposal Field: Distance from nearesteH--- Distance from foundation____- --------- it g ,S.-T _.Width of french------- '�f------•----------- Number of lines---------------------- -___ _ -Length of each line-_____r /�_.__De th of filter material____/-'._--_ .Total length___ ------------ ----------•---- Type of filter matenal.�F___ --- p Seepage Pit: Distance to nearest well---------------------- from foundation__.-----------------Distance to nearest lot line---------._-___-_ ❑ Number of pifs----------------------Lining material----------- -----------Size: Diameter-------------- --------Depth------ ------------- --------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----._____--__________-______________. ❑ Size: Diameter --- ---- Depth__. - --------------Liquid Capacity---------------------------gals. O Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building------------------------------------------ ❑ Distance to nearest loft line------------------------ - -- ------ --------------------------- ------- --------I------------------------------ Remodeling and/or repairing (describe) ------- ----------------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules regulations of the San Joaquin Local Health District. 'it�i___ (Owner and/or Contractor) 5ined - ----------- ------•------------------- ----------------------- -------- ---•--------- - - --------------------------------------------- (Title)----------- -.1-------------------=--------- ----------------- (Plot plan, showing size of lot, location of sy em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - -------------------------------------------------------- DATE '2 2 ----------------------- - DATE ---- ----- --------------------------------------------- REVIEWEDBY------------------------------------------- -------- ------------------------------- PERMIT ISSUED-------------------------------------------------------------- - ----. DATE----------------------------------------------------------- BUILDING - --- Alterations and/or recommendations------------------------------------ ----------------------- FINAL INSPECTION BY:--------------�------------------------------------------ Date- ----------------------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT i32 Sycamore Street 814 North "C" Street 130 South American Street 300 Wast Oat Street Trac California Stockton, California Lodi, California Manteca, California Y. ES--9-2M - Revised 1.57 F.P.CO.