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APPLICATION FOR SANITATION PERMIT Permit No. ._.�.�.. _ .. (Complete in Duplicate) ` Date Issued This Permit Ex i res � Year From Date Issued r� 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 No, 549. JOB ADDRESS AND LOCATIONJ----*-"� o ji Owner's Nam ------ --Wit---- -�'---'-"_�"�------•---•- - 7r'�I -�------------ ----------- ----- Phone_ Address-------------- ------ ---- -- Cantractor's Name ---------- = --� s�a � __ Phonel -- -----A.2---------�--- - - ------ X 70- ❑ ❑ Trailer Court ❑ Motel ❑ Other Installation will serve: Residence Apartment House Commercial Number of living units: __1--- Number of bedrooms _-- umber of baths /_-_._ 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 Hardpan ❑ Previous Application Made: Yes ❑ t No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s e tic T rale` Distance from nearest well-----------------Distance from foundation--.-----._ -+_-. -.-.Materia# No. of compartments Size ------------Liqui depth---------- __..-__-_________--- ___--------------Capacity..--------------------- i oral a Distance from nearest well_. _._--Distance from foundation - t - -D-_-.-_-__Distance to nearest lot line Number of lines_::._r_-_-- _\_ Length of each line--__- -----__ `� Width of trench.-.off--r, // _---.- --•--- Type of filter material------ ------- � Depth of filter material.---1 ------ ----Total length----------�0_ ----_--_-----_--- Seepage Pit: Distance to nearest well----------------_----Distance from foundation--------------------Distance to nearest lot line----_------_----. ❑ Number of pits--.'------------------Lining material------------------------Size: Diameter----.------ -----Depth--------_------------------------ Cesspool: Distance from nearest well--------------_-Distance from foundation....----.-------__-.Lining material-.-_-.-..----.--____---.-__ ' -------- Size: Diameter == Depth Liquid Capacity -------gals. Priv 1 Q y� Distance from nearest well______ ---------------------Dis+ante from nearest building ❑ Distance to nearest lot line------------------------•-------------- -------- - Remodeling and/or repairing (describe):------------------------------------------------------------------------------ ----------------------------------------------------------------- I hereby certify that I have prepared this application and fhat the work wi 1 be done in accordance with San Joaquin County ordinances, S e laws, and rules and regulations of the San aquin Lacal H Ith District. s 4_ ___ � -- --- ------------ -------- w Contractor) 1 By:----------------- --------- --------•-•-------_---- T�fle (Plof plan, showing size of lot, location of system in relation wells, buildin , etc., can be placed on reverse side). FOR DER RTMENT USE ONLY --� - � APPLICATION ACCEPTED BY------------------------- ----- -- ---------- DATE----- �- - ------------------------------------------------ REVIEWED BY-------------------------- ------------=�- - - --� --- - DATE---------�---- Z'Y7 ,�'�'--------------- ----�- - --•-------------------------------------- UiLDING PERMIT ISSUED `------------- - -- -------------------- DATE ferations and/or recommendations:--_------------.__---------------- --- - ----- -- ----------- -------- ------- -- ----------------- ----------------------------------------------- ----- -------- ----- - --------------- - ---------- -------------- •-------------------- -------------------- ------------- ------------------- ------------ --------------------- FINAL INSPECTION BY:-------------- ------------------------- -------- Date----------- -f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Siockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Cc.