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APPLICATION FOR SANITATION PERMIT Permit No. . -. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin ocal Healfh District for a permit to construct and install the work herein described. This application is made in compliance with City Ordinance No. 544. JOBADDRESS AND LOCATION------6 -3 X11- ----------------------------------------------------- -------------------------------------------------------------------------- Owner's -------------------------------------------------------------------------- y - Phone - Owner's Name---Owl l-------.._- r f1/a Address--------.- h'a------ ---------- ---------... ��.i-------------------------------Z: Contractors Name--_-__-..., � - Phone,- Installation hone Installation will serve: Residence �� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other J ❑ Number of living units: --'�---- Number of bedrooms -- .- Number of baths ---1_-- Lot size _--_ .- -_.-_.��-- -------------------- Water Supply: Public system ®` Community system ❑ Private ❑ Depth to Water Table _! ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'2]—Hardpan ❑ Previous Application Made: Yes ❑ No [�' New Construction: Yes E4 No ❑ FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r -- Septic Tank: Distance from nearest well-`�'�"------Distance from foundation_-4p-----_--_-.Material---_TgJ44!5.5-60 .�___-.-_-- f Ca acit ca No. of compartments -Size.. rte' S`+`� _j- ---Liquid depth------- ---------- P Y - D:sposal Field: Distance from nearest well...-- ---------Distance from foundation--_.-]�.`.0--"-_----Distance to nearest lot lin e---------f.----. Q Number of lines--------------- -- -----------Length of each line------ ---__-----.Width of trench.---- ----`----------------- Type of filter material----'- €._-Depth of filter material----A-__-------Total length-----4------------------------------ Seepage Pit: Distance to nearest well.-.---�-------------Distance from Q foundation-_-_kC?____-.'.Distan e to nearest lot ne-_'5--_F--. Lining material-- Number of pits--------- _7o-&4...Size: Diameter___ ----- Depth-_-----------------------__---_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- Size: __----------.----_--__-___._----.Size: Diameter--------------------------------------Depth--------------------------------------------------- 'Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.-----.-_--------__------..-.-.-_.__. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------- ---------- Remodelingand/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, State laws, and rul s an regulations of the San Joaquin Local Health District. (Signed) ___.----(Owner and/or Contractor) SY:-------------------------------------------------------- -------------------------------------------------------------- (Title)--------- ----------------------------------------------- - ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR EPAR MENT USE ONLY 1 APPLICATION ACCEPTED BY- ------ -- ---------------------------- DATE------.�_._.�j_-:� ----------------------- ---------- REVIEWEDBY------------------------------- --•-- ---------------------- - ----------- ----------------------------------- DATE------------------------------------- -------------=------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------ ------- - ----------------------------•------------•--•----------------------• ---------------------------------..----------------------- - E ---------------- ------------------------------------- -------------------------------------- ----------------------------------------------------------------------------/-------------------------------------------- a•�FINAL INSPECTION BY------------------------ Dated 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 6-'59 f.P.Co.