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f APPLICATION FOR SANITATION PERMIT Permit No. ___�� •_3____... (Complete in Duplicate) Date Issued 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 549. JOB ADDRESS AND LOCATION---- Gam• -------- ------------------- -- T- Owner's Name - ` Phone '".." ----------- ------ Y. -------------------- Address--------------- -------- �/ "" -------------- ,F Contractor's Name -" = = = ---------------------- ------ Phone.--•----------------------••------- Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.l---- Number of bedrooms _J- Number of baths __Z-- Lot size S�_ ------------------- ---- r 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 El Clay Loam El Clay F1 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes No �HA/VA: Yes ❑ No E' TYPE OF INSTALLATION AND SPECIFICATIONS: X (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material -_-.___--_--_____________________-._.----------- No. of compartments-------------=------ -----Size----------------------- Liquid dth------ -------------- ----Li e - ---Ca acifi q P P Y --------------------- Dislowal Feld: Distance from nearest well----.-..r..' _.Distance"from foundation___AL�--------•Distance to nearest lot line__�_____f_. o -ines---- - -- Length Tf each line_________ _2 r Width of trench _Number material____-� r---.-Total length________, -. -- ----------------Type of filter material�Aef. d s� �g 7 r Seepage Pit: —`,Distance to nearest welL.____"f______Distanc`e from foundation____x�- -_.Di tante to nearest lot line__ _________ __ Number of pits;'.:_--/-----------Lining material_-- .size: Diameter._. Depth Cesspool: Distance from nearesf well-________________Distance from foundation-_------------------Lining material_____.__________-.-.______________._- ' ❑ Size: Diameter------- ------------ -=----------Depth-------------------------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-__.______________________________;Y-_.--_- .-Distance from nearest building----------------- ------------------------ Cn ElDistance"to nearest lot Dine-- ---------- -- - - .;------------- --------------------------•-------------------- ------------------------------ , 3 -------- -------•-----------•---------------------------•-------- Remodeling and/or repairing (describe)---------------_.��G�r'�'`----- - - - ----- - --- ------------------------------------------------------------ _______ ------•------------------------------------------------- I hereby certify that I have prepared chi's application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -� -_._ _._. r Contractor) (Signed) --- ------- -- - ---------------- ------------ BY: ------------------------------------- ------ -------- ;.- el i ---------------- -(Tltl e --------------- - ------------------- -- - (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be pl on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY__—T�--R -"------ --------------------- ---------------------------------------- DATE-------- �� REVIEWED BY--------------------------------------------- ---------------------------------------------------------- DATE----- ------------- ------ ------------------------ --------- BUILDINGPERMIT ISSUED-----•---------------------------------------------------------- -•---- DATE------------------------------------------------------------- Alterations and/or recommendation :-______-__________________________ __ a r___.. art Q.k...... - -gib_:_ ---- --------------- .- -------------- --- } -------------------------------------- ------------------------------------------------------------------- FINAL INSPT Date_ / � ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT N . 130 South American Street 300 West Oak Street 132 $yeamoreScree+ 814 North "C" Street Stockton, California Lodi, California ,Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.CD.