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PP LICATION FOR SANITATION PERMIT Permit No. ...�f l� t (Complete in Duplicate) v Date Issued This Permit Expires } Year From Date Issued Application is hereby mad 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 AN?)LOCATION -- ---- -------------------------/---- -------- ----------------- ---- ---------------- Owner's Name________ _ ---------------------- Phone-7; ---_ ��Z_ ---- --- - ----- -------------_-------- Address-- / ... ��ff_ Contractor's Name -- R �--------------------------------------•---- Phone,!> __O__-1�jO7.. Installation will serve: Residence M-7-A`partment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑' Number of livingunits: _ —" �__- Number of bedrooms : Number of baths __ _____ Lot size ___�� _ _____ ___. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table/G?ft. Character of soil to a depth of 3 feet: Sand [�avel ❑ Sandy Loam ❑ Clay Loam ❑ . Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes RT<o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if�]ublic sewer is available within 200 feet.) Septic Ta Distance from nearest well-/ Disfarxe ffom foV1da�on__-/4Z_'__./Mat/eriaj_ No. of compartments-----tT"- ------ . —__3>3___Liquid depth---/ -- ---------Capacity. Oisposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________________ Number of lines----------------------------------Length of each line----------------------------..Width of trench=-----------,-----_--------------- Type of filter material--------------------______Depth of filter material_.---------------------Total length------------- ---_-_----_---_--------- � Seepage Pit: Distance to nearest well-----_------------------Distance from foundation--------------------Distance to nearest lot line--__-----_-_--_-. ❑ Number of pits-----------------------Lining material---------------------- Size: Diameter-----------------------Depth-;--------------------------------- -Cesspool: - ----Distance j from-neaxest 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)---------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------------------------------------------------------------•---------------------- ----------------------------------------- I hereby rtify that I h repared this application and that the work will be done in accordance with San Joaquin County ordinances, at I ws a r les nd regulations of a San Joaquin Local Health District. (Signed)-------- ------------- -- - - -------------------------------------------------- -- ------Owner and/or Contractors , or By:--------_--------_- - -- -- - -- - ---- Title A -- (Plot plan, showing size of lot, location of system in re �we buildings, efc., can be placed on reverse side). I ] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -------------- ----------- --------------------------------------- DATE----------�- - ---- ff REVIEWED BY------ ---- ---- ------ DATE---------- (Y_------------------------ BUILDINGPERMIT ISSUED-------------- ------------------------------- ------------------------------------------------------ DATE------------------------------ ----------------------------- Alterationsand/or recommendations----------------------------------- -------------------------------------------------------------------------------------------------------------•-------------- ----------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------------1----------------- ------------------------------------------------------------------------- I--------------------------------------------------•------------------------------------------------------------------------------------------- -----------------•-- ----------------------------------------------------- --- -----------------------------I--- ------ - -----------------------•-------•---------------- -------------------•-------------------------------------------2------------------------------------ ---------------------- FINAL INSPECTION BY-------- --------------- Date---------' --- ------------------------------ SAN I 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.CD.