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• Ip�l "i��V ali �� 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 Local Health District for a permit to construct and install the work herein'described. 4 This application is made in compliance with County Ordinance No. 549. p JOBADDRESS AND CATI N------- �!_ --- a - ----------------------------------------------------------------------I------- Owner's Name- --- -e --------------------------- ----------------=------------ ----------- - Phone--------- -•-----------•-------•---- Address -----_-----------------------------------------••---------•---------------------•----------------•-----------------`---•----------------____--•-------------------------•--- ,# Contractor's Name------------ ----------------------------------------------------------------•--------------• ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _.�--- Number of baths :Z__ Lot size ----___________________________ t� f Water Supply: Public system F1 Community system El Private [�epth 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 ❑ No 2�' New Construction: Yes 1❑ No [� FHA/VA: Yes ❑ No ®r' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic'Tank: Distance from nearest wel3----7P......Distance from foundation----le_�___._Material---- _ _ .f'/ ®� No. of compartments--------.2-------------Size--jZ_A_VQ-------._Liquid depth--- 1�--------------Capacity__, � _-•-- Disposal Distance from nearest well..• _,r _.Distance from foundation____!e__ ------Distance to nearest lo` line___ L W' Number of lines________ ___ _ ��— Width of tren Length of each line ------------------------------ 41, Type of filter material /�i�G 'Depth of filter'material-_A "---------Total length______ __w--------------------------- Seepage Pit: Distance to nearest well----?,a_________Distance from foundation_____.)4P '. ace to nearest lot -Number of pits.____._-______-Lining material---/f -__.Size: Diamete �____..._ Depth_____A; f-w------------ -� Cesspool-. Distance•fi-om neares+„well____--______--'-Distance from foundation.__________________Lining material------ _______.____ ❑ Size: Diameter-------------------- "_.- --------- Depth---------------------------------------------------Liuid Capacity ---gals. Privy: Distance from nearest well ---__-_---.__-_Distance from nearest bui{ding---------------------------------- ------- ❑ Distance to nearest lot line-______________________ Remodeling and/or repairing (describe):--_'.--- ------------ ...� ...T. -- � . -------------------------------------------------------------------------------- ------------••--------------------------------------------------------------•-----------------------------•--- ------------------------- I hereby certify +hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws�ancdlrule and regulatTions'of +he San Joaquin Local Health District. ------ ----------------- ----- r Contractor(Signed)------;•=---------- -• J,,q ' ° BY:---------------------------------------------------------------- M__!_ . {Title) d t� /t' `- (Plot plan, showing size of lot, location of sysfe n relation to wells, buildings, etc., can be-placed-on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY -------------------------------- ------ DATE- ----------- f REVIEWED BY------------------------ , ---- DATE--- ` ------------ - - BUILDINGPERMIT ISSUED------------------------------------------- -----------------------------------------------------._ DATE,---=------------------------------------------------------- Alterationsand/or recommendations:_---- ---------- ----------------------------------------'----------------------------------------•----------------•--------------------------------------- 4 f, --------------------------------------------------------- "' '------------------------------ - - FINAL INSPECTION BY:---- - - - --- - ------------- Date_....— -6-.Q._----------------------------- SAN JOAQUIN LOCAL HEALTH,DISTRICT% I sI, - l 130 South American Street 300 West Oak Street �'-�132 Sycamore Street 814 North "C" Street. Stockton, California Lodi, California Manteca, California Tracy, California E5 9`2M Revised 8-'59 F.P.Co.