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APPLICATION FOR SANITATION PERMIT Permit No. -_.'3_____ (Complete in Duplicate) Date Issued ___ h __ 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 Ordin ce No. 519. JOB ADDRESS AND ATION. c `. ---- -f J--------------------------------------------------------------------------- Owner's Name------------- - - ----------- -- -- ----- ----------- Phone --------- - Address -------------•--------- : ------------- Contractor's Name ------- ------ ----------------------- I ----------------------------------------------------------------------------------------------------------- Installation will serve: Residence Apartment !"louse ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: __/._ Number of bedrooms _,`,� Number of baths _1__ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table d%°ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gj—H-6rdpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No Uj--FHA/VA-. Yes ❑ No [r----�- f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sytic Tank: Distance from nearest weff-----------------Distance from foundation--------------------Material-------------------------------------------------- 45 _-________._________________________________.45 No. of compartments--- ----------------------Size----•----------------------:---Liquid depth--------------------- ----Capacity-•--------------------- Disposal Field: Distance from nearest �velf------ -------Distance from foundation_--1�__ ----'_Distance to nearest lot line.-t4_--___.___ (� Number of lines---------- ---- ---------------Length of each line--- Width of trench-----Af-________._-______-_- �- Type of filter material �t/Gj�ADepth of filter material__--ZY---__------Total length------ i Seepage Pit: Distance to nearest well___--:!' -------Distance f.prro''m foundation____/K_-..__..Distance to nearest lot line__ .' Number of pits-_-__/________---Lining material__- ,o< Diameter---c.�, _---------Depth--1P—�------------------ r` Cesspool: Distance from nearest well______.------Distance from foundation________________-_.Lining material___-_______-------- _ CSI ._____-_-- _____- ❑ Size. Diameter---------------- ------ :Depth_---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well -ter_____________ ---------Distance from nearest building___-______._-----________-__ ❑ Distance to nearest lot line--------------= --- ---- ----------•--- Remodeling and/or repairing (describe):-------___-__ _ -_--------•---_. ------------------------------------------------------------------------•------•---------------------------------- ---------"------------------------------------------------'--------=------•-----------•-----------------•-------------------------------------------•-•-----------_-------------------•----------------------------------- 1 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 a regulations of the San Joaquin Local Health District. (Signed) --- ---- ----------------------------------------------- ( r Contractor) BY: = -----------------------(Title)----- ------------------------ (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-__" ___"-__ ------------------------------- 1jQ REVIEWEDBY-------------------------------------------------------------------------------- -------------------------------------------- DATE ----------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE------------------------------ Alterations and/or recommendations---------------- ------------------------------------------------------------------------------ --------------------------------------- - •------------- ---- -- -------- ----•------I----------------------------- ------------------------------------------------------------------------- 247 FINAL INSPECTION BY Date-----j054--C SAN JOAQUIN LOCAL HEALTH DISTRICT .;7 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California k t Manteca, California, Tracy, California 5 ES-9-2M , Revisep 1.57 F.P.CO.