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APPLICATION FOR SANITATION PERMIT Permit No.:�:._/_.l.lp.`r.r �.. (Complete in Duplicate) Date Issued ------__l..__Y..-- 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 No. 549. JOB ADDRESS AND LOCATI N•.•. �J�°+�. -------- - --- ----•-•--------------- -- -------------------------------------- ------------ --- - - Owner's Name------ -------•------------------------------------ ------------------------ -------------- Phone------------------------------------ ---------------------------------------- Address__----------_- l Contractor's Name-- ---- ------ - - ---------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ElN umber of baths - Number of living units: J--- Number of bedrooms _ Lot size _ > - -� ---- Water Supply: Public system U11-Eommunity system ❑ Private ❑ Depth to Wafter Table,5�z_`ft. Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E31"A"ardpan ❑ Previous Application Made: Yes ❑ No New Construction;_Yes.,Ej1lo ❑_ FHA/VA: Yes rd"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,��rr Septic Tank: Distance from nearest well__._--�»Distance f om founclation----le------Material__--__4r�� -- --------- _Liquideth___ 4 d ��-- No. of compartments- __ cy (/- _ Disposal Field: Distance from nearest well__--...___ ---Distance from foundatio _Z4 --------Distance to nearest lot line__��__--_ fi Number of lines--------- ______ --___.Length of each line_______9' ,a- of trench___ _____ __________________ of filter material__ - Depth of filter material____. a-_.fir----Total length___.____ -------------------------- Type � o` Seepage Pit: Distance to nearest well-_____ ^ ____Distance fr m foun'dation_F, ^� /�------- nce to nearest lot line___ _____ I ` Number of pits.--- - --_______Lining material__ 4 -..Size: D:ameter._� .....__-____Depth_. r -------- I Cesspool: Distance from nearest well-----------------Distance fromoundat:on--_._-_________---.Lining material__________________________.____-.___. X ❑ Size: Diameter --------..Depth-------------'. -----------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ _. - _ �- ❑ Distance to nearest lot line--------- ------------------ ----- ----------------------- - ------------------------------------------------ --------------------- Remodeling and/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 t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Contractor .. T�+le ---------- ------ - t BY:----------------------------------------------- --- - -------- - -'--------------- ------- : - = :( ) (Plot plan, showing size of lot, locati f system in relation to wells, buildings,:etc., can be placed on reverse side). FOR DEPARTMENT.-USE ONLY- _ , APPLICATION ACCEPTED BY-----�-__C'--_i1--- ------------------- ------ -- DATE ----J-------��------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------ •------- DATE-------------------------------------------••-------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- -- DATE-------------------== -------------------------------------- Alterations and/or recommendations--- ----------------------------- -----------------• 0----------••-----------------------•-••---•----------•-------;{=-------------------••----------- ./t' `...•� � - --&--�-----'r__- ---'"''�'?'` ----------------aye- �-�----'------------------ --------'------------------- -----------------•-- A FINAL INSPECTION Date_ -------------------- ---------------------- - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3oo West Oak Street +t]132 Sycamore Sfrreef A 814 North "C" Street k `}W Mteca, \ Stockton, California Lodi, California anCalifornia Tracy, California ES-9-2M Revised 8.'59 E.P.Co.