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Co �3 APPLICATION FOR SANITATION PERMIT Permit No:`.,./..-.-._7.j_7 - (Complete o.'.,./..-.-..-7.-_--_7 (Complete in Duplicate) / ff � Date issued ---.----.�/�_f„ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct�tnd install the work herein described. This application is made in compliance with ounty dinance No. 549. ..LL 12-3 JOB ADDRESS AND LOCATION... - ---- ------ ---- �"_ ' } Owner's Name------------------------ --- ------- ---- ----- ----- Phone-----=----- ------- - - - --•------ -- •- Address---------------------------------- � ------ --- ------ ---- ----=�}------- - . ................ # Contractor's Name---------------------- --------------------------------- ------- --------------------------------- ------------------------- Phone----------------------------------- Installation will serve: Residence [Q Apartment House ❑ Corr ial''❑ -Trailer-Court E]- Motel•❑ Other ❑ Number of living units: ___�__ Number of bedrooms _._ Number of baths _-/-- Lot size _ - --.1_ ----------------------- Water Supply: Public system Community system ❑ Private ❑ ' Depth to Water Table -------- ft, Character of soll to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Zo'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [] No ga` New Construction: ffY��es URI"-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitFed if public sew r`1s ava#rabreWithin 200 feet t F r 3 Septic Tank: Distance from nearest well___rqDistance from foundation-_ Material-------- --- -- -- --- ------ No. of compartments-----. .- Size-_ ----Liquid depth__-_-- -.___-___-..Capacity.l - - Disposal Field: Distance from nearest well.-:0 ance from foundation_/Z Distance to nearest lot lin` Number of lines------- -- Length of each line__---- -5 --.�--Width of trench-___ - ------------------- Type of filter material----_ � � Depth of filter materia(--,)-F�� Total length Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- q� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_----------------------Dept{i-.-.----------------------------- yy Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.--..-..-.--_.---------------------. Size: Diameter--------------------------------------De th----------------------'---------------------------.-Liquid Capacity gals. Privy: Distance from nearest well -------------------------------------------------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 and regulations of the, an Joaquin Local Health District. _ (Signed)------- �.I l l - --- ----- ---- ' 4 ------- -------- -------------------------------------------- ---"«--------(Owner and/or Contractor) � ale By------------------------------------------------------------------------------------------------------------------------------------((Tif )---------- --------------------- ------- -_ (Plot plan, showing size of lot, location of system'in relation to wells, buildings, etc., can be placed on reverse side). OR ARTMENT USE ONLY APPLICATION ACCEPTED BY_ /. _ ------------------------- DATE-�_. -_-/_. -------------------- REVIEWEDBY--------------------------------- ---------------------------I----� ----------------------------------- --- ---- ---.-. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------t---------------------------------------------------- Alterations and/or recommendations------------- -- ' I r f ------------------ •----------- ------=------------._-•--------------------------------------------------------------------------- `------------------------•---•------------------ S ------------ --------------------------------------------------J--------------------•------------------------•--•------------- r -------------- ---------------------------- ------------------------- ------------------------------------------------------------------------------------'------------ ----- ------------------ • ---------- , -1i- --------------- ------- ----------------------- ---------- ------....------------------- -------'-------:_------- •----..--.--.---------- ------- ---.--.-.--..-..--------------'------- FINAL INSPECTION BY------------- -- - -- -- ------- — Date---- --- ---�✓ 4-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ 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.