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- 1 -.-.3':--;= •-)APPLICATION FOR SANITATION PERMIT Permit No. 4 1 (Complete in Duplicate Date Issued C)This Permit Expires 1 Year From Date Issued 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 Or finance No. 549. Ord AND LO TION x �� `zF= -- ----------------- JOB ADDRESS G L ------------ Phone Owner's Name ---- --------------------------------------- ----------- --- ----------- Address-___..---___ Contractor's Name--------------- ------------------------- ----------- *----•---------------------- Phone----------------------------------- Installation will serve: Residence 1�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___?Number of bedroom_ Number of baths/� Lot size--1�ell Supply: Public system ❑ Community.system [ rivate ❑ Depth to Water Table _ tt- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ??""New Construction: Yes Tg''No ❑ FHA/VA: /Yes Z o El TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from foundation---le-__.-"_Material____ __r 1 r- ---"---- Septic Tank: Distance from nearest well.______' .�•� Capacity/4944. . l� dvt�_-4�------Liquid depth____. - -------------Capacity/�� No. of compartments:..___ _._.Size_ '" '�--""" Disposal Field: Distance from nearest well,i: ..._Distance from foundation."-.. Distance to nearest lot line__, ':-___ yy j Width of trench___.__ .r!-------- -------- Er" Number of lines-______ems Length of each line._ __ __ `l Type of filter material-_ Xi� Depth of filter material_-,�,�___"___..Total length__.__ � ""-"-----------------.--- _,_ ` " - i' �/_Distance to nearest lot Pit: Distance to nearest well________""'___---Distance fr m foupdation____ ------. i.� �: Number of pits______�_..________Lining materiel_ . ___ ._� _.___-Size: Diameter__ Depth ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material-------_.--__"-._-_.-___-__.--"--___-. ❑ 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)=--------------- ------------------------------------------------------- t ------------- --------- ---- -------------------------------------------------------------------------------- - 1 p _ -- _ ----__"--------------- --------------------------------------------"-"____---"__-__--_-__.----______---_--______--_"___.._-._----.____.-_---..__-____- 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 rules and regulations of the San Joaquin Local Health District. 1' 9wrrcT-mn474r Contractor) gy;__. ---------- -------------------(Title)_-- - G� *(Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed-on-reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ------------------------- DATE DATE REVIEWED BY-------------------------------- ---- -------------------------- --- ----- ----- �- ' - BUILDING PERMIT ISSUED------------------- ---------------------------• DATE-----------------------------t---------------6-----------0----------------------------------------------------------- ------- - Alteration -- ------------------- Alterations and/or recommendations:-------------------------- ------------------- r ------------------- ------------- ------------------------------------------------ 6Q, --------------------------------------- ----------------- ------------- INSPECTION BY------ ----------- --- ,- Date-------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30o Wei Oakistre�t; i ^'R 132 Sycamore Street t 814 North "C" Street f Stockton, California Lodi; California Manteca, California . i_ Tracy, California ES-9-2M Revised 6-'59 F.P.Cc- -