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APPLICATION FOR SANITATION PERMIT Permit No. 1f" (Complete in Duplicate) This Permit Expires 1 Year From Date Issued bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instail the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. _jrs,_.1W__JOrnPx - __________._._- Owner's Name------- -- -------------P--h--o--n--e- - --- -- - - --------------------- - Address---------f-.7--- e....----- ----- ------- ------------------------------------------------••---------------..-..---•-------------------------------•------•-----•-•------------------------- Contractor's Name-------- -- ; - ----- F F S --------------------------------------------------------------- Phone----••-•----------------- Installation will serve: Residence [4-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A._-- Number of bedrooms -12-. Number of baths -1----- Lot size ---..��-��`d----------------------------- Wafer ------------------ ---Water Supply: Public system ®KCommunity system ❑ Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B"Hardpan ❑ Previous Application Made: Yes ❑ No UE' New Construction: Yes E�r"No ❑ FHA/VA: Yes ❑ No DR'' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well------�------Distance from foundation---I -------------------. No. of compartments........A-A------------Size------- -x5 �-____Liquid depth----- ---------------Capacity---8po-. ,P/ Disposal Field: Distance from nearest well----.-..--- Distance from foUndatiort._ � p .-___- ..-.._�____-_-Distance to nearest lot iine_��______________ R Number of lines-----------------------_-___.-_Length of each line----_----_41r-----------Width of trench--------- .---.---..------_ Type of filter material-------'$D.f,.K----Depth of filter material-1-T'--------- -Total length_---------g_0----___--___--_---_- Seepage Pit: Distance to nearest well___-.___"'~-------Distance from lonclation-_.�_�-_s--.Distance to nearest lot line-_..--_----_.-Number of pits------- ------------Lining material_.-- (�_� ...Size: Diameter.----__<(--______-Dept h---------- --------------------- Cesspool: °----.-._--------- Cesspool: Distance from nearest well-----------------Distance from foundation Lining material--_._-----_----.-------------------. ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------_.____-______--.--__----..---_----. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------:-------------------------------------------------------- Remodelingand/or repairing (describe)----------------------------------------------•--------------------------------------------------------------------------•-------------------------------- ----------------------- ------------------ ----------------------------------------------------------------------------•----------•-------------------------- ---------------------------------------- -------------- ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, and rules and regulafi ns of the San Joaquin Local Health District. (Signed)------------ ------ -- - - ---•-------I------------------------------------------------------ -------------------- ---------------------(Owner and/or Contractor) By:-----------•-----------------------------------------------------------------------------------------------------------------------(Title)---------- ---------------------------------------------------- (Plot ---------------------- ------ - ---- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----'_'K- Z',::>-f----------- ---- ------------------------- DATE- ---------------------------- -- --------------- REVIEWEDBY------------------------------------------------------ ---------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDINPERMIT ISSUED----------------------------------- -------- --------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------------------------------------•-----•-•------------••----- ----- -------------------------- ----------- ---------------- -------- ---------- �T ---hLPTH-----�--� PTr -------T7_9 a,1 :---•-- T' - � 3p-6 -------•------------------------------•------------------------- ----- --------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTIO ----- --------- ------- -- Date-------- -��Q Ca SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 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.