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•Y Permit No. ._.�1_-�G-.�' APPLICATION FOR SANITATION PERMIT ` l (Complete in Duplicate) Date Issued .- /i//_�U• This Permit Expires 1 Year From Date Issued d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install#�S her describe -0�e This application is made in compliance with County Ordinance No. 549. G. ` -Z - JOB ADDRESS ANL ATIONj " Phone---"-E`-`------ _ f - . -------- �Owner's Name Address---------------- ' --•--- --------------------- •--------------------- ----•-------------•--------••--------•...-----------. ..----------•-------- Phone--------------------- ---------- --------------------- Contractor's Name Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units; Number of bedrooms 3--.- Number of baths I------ Lot size .>'- _ -'C____________________----.- --------------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table30--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 91 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ NoEja FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: { n (No septic tank or cesspool permitted if public sewer is available within 240 feet.) "S Septic Tank: Distance from nearest well---------------- Distance from foundation-------------------.Material------.-__----..------------------------------ ❑ No. of compartments---- --------------------Size-------------------------------Liquid depth---------------- --------Capacity..--------------------- Disposal Field: Distance from nearest well------_-----------Distance from foundation--------------------Distance to nearest lot line----------------- ttt ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench.--------------------------------•-- Type of filter material---------------------_-Depth of. filter material-----------------------Total length------------------------------ ------ Seepage Pit: Distance to nearest well-___10l 0---------Distan4erom oundation_.-�?------___.Distance to nearest lot line_-_-S_--____-._Number of pits-____---------------Lining materia Size: Diameter._- -----------Depth------- ----------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------ ning Capacity_.material______--____--___--____- gal - ❑ Size: Diameter------ •--------- -------------------Depth------ -------------------------------------------- Liquid -----------------------gal Distance from nearest well------------------------------------ Distance from nearest building------------------------------ ----------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- ------------•------- f rP/ Remodeling and/or repairing (describe):-__________ __ _____ _______ U ------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ----- l hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State;;and,rul and regulations of the San Joaquin Local Health District. ------------- -------(Owner and/or Contractor) (Si n ----- ----- - - -- ------- --------- Title (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 DAT APPLICATION ACCEPTED BY---- E�' -+ ----------------------------------- --------- - - - DATE----- ---------°--4)---------------------- REVIEWED BY-------------------------------- - ---- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- Alterations and/or recommendations:__--_.-_............ ... ----•----------------------- --- ------------------ FINAL INSPECTION BY:.._- ----------------------------- SAN --------- ---------- ------SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street frac California Stockton, California Lodi, California Manteca, California y FS-9-2m Revised 6-'59 F-P.CO-