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.orf APPLICATION FOR SANITATION PERMIT Permit No. ---.�_- -�J-l- (Complete in Duplicate) Date Issued ----/- ---Ik 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 Ordinance o. 549. JOB ADDRESS AND LOCATIO - . � --- ----- Phone-----:r=----•----------------- Owner's Name----- ------------ -- Address__...... ----------------------------------------- ------------- -------------------•---------------------------- •------ ............ Address.. ------ - // Contractor s Name_____ ----------- Contractor's Name----- --------- ------ {1. ---------------------•------------•-• Phone. . .._.4.- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 i Number of living units: __/.-_ Number of bedroom---- Number of baths/ _____- Lot size _-.- �-- -• f ' Water Supply: Public system74Community system ❑ Private ❑ Depth to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)j�ardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No",-_EHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , J [No sep+ic tank or cesspool permitted if public sewer is available within 200 feet.) eptic T Distance from nearest well---------- _ __Distance from foundation-----------------___Material.......................... No. of compartments---------------------• --Size---------------------------•---Liquid depth--------------------------Capacity •-------- ''++ .._Distance from foundation..__)©---_.-_Distance to nearest lot line-_�---- 1V posal elm Distance from nearest wei1.141 Number of lines-_-_1____ ____________ ______Length of each line_ --o . -----------Width of trench__ .�,��-------------- De th of filter material__--f�f�------Total length---------------1-40-e---------- �..�3 �� Type of filter material��- - p Seepage Pit: Distance to nearest well__Noue--------Distance from foundation___.- Distance to nearest lot line----- Number of pits-____I---------------Lining material__��- _Size: Diameter._. _��1t._...__Depth__.4--v----------------- 9, Lining material------------------------------------ Cesspool: -"---"--------- Cesspool: Distance from nearest well-----------------Distance from foundation._-__-____--._..____Lining material__..__ _._-_._.___, ❑ Size: Diameter--------- - -_.Dep h----------------------------------------------------Liquid Capacity--------------------- gals, Privy: Distance from nearest well------------------ --- -------------------------Distance from nearest building------..__.________-------------------- ❑ Distance to nearest lot line- -.-.._ -- ------------•----------------------- Remodeling and/or repairing (descri e):------ ---- -- ------------ -----------•---------------------------------------- --------- ------------------- -- ----- _612— - -- -- ------------------- ------ -------------------------------------------------------•------- - - -------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, and rules and egulations of the San Joaquin Lo al Health District. (Signed)__ ZD ---��-ag��-__.�� f_� .. .�---- ------------- - ----------- ------------ ----[ Contractor) S -----(Title)---------------------------- ------------------- -------------- g p (Plot plan, showing size of lot, location of system in rel on to wells, buil s, etc., can be laced on reverse side). - FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY_---. r__�-�- -- >�`� DATE �� __ _ _ DATE--------�--------�------•--- -----�----------------------- REV EWED BY BUILDING - DING PERMIT ISSUED---------------- ----- --------------------------------------------------•--- -------------------------------------- DATE------------------------------- --- ------------------- -- Alteratio s and/or recommendations:----------------- -------------------------- ------------------------------------------------------------------------•----I---------------------------------- -- -°---------- ------------- -------- --------- l --------- mac.-- l - ------------------ ------------------------------ -------- ---------------------- ------------------- 4 y FINAL INSPECTION BY:. - ----- ----- Date--- ------ ,j( ----- /-------------------------- ------ l 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.