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i APPLICATION FOR SANITATION PERMIT Permit No. ._i. _.3�:r.... 1 (Complete in Duplicate) $ This Permit Expires 1 Year From Date Issued Date issued _----__________________ Application is hereby made to the San Joaquin Local Health District for a permit to construct andin all t work herein described. This application is made in compliance with County Ordinance No. 549. , JOB ADDRESS A LOCATION------- -_--a --------------------- 00 Owner's Name ., , ---------- --- --------------- -•------------------------------ - - ----- Phone------------------------------------ Address d --- kv--t� P��-4- ��r Contractor's Name--1�'��/) -•-�, p.��'_ _.. �_,��•�c'��---------------••------f��_ _ Ph©Re-•- +--•---...--•---- f Installation will serve: Reside Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number NrKs _J___ Lot size __________________________________________ Water Supply: Public.-system x Community system ❑ Priva4e4ArDepfh to Water Table &0__ ft. Character bf soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No•E� New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -Is (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - � --- O s .4 - - - - Septic Tank: Distance from nearest well__----------Distance from f undation_ld ______-_.Materia- --------------p ____________- No. of compartments _______Size_ _ Liquid de th_____�t Ca acit Qr _______ p p � ----------- q dep `1='------------ --- P Y-- ------- Disposal Field: Distance from nearest well-- .__--------Distance from foundatipn�l6 Distance to nearest lot line---' rte, Number of lines__________. `_- Length of each line______________ Width of trenc�_._ ------------------ ----------- __________ Type of filter materia _--------------------- p g +1!_De th of filter material____ _- - - . Total length __________________________________ Seepage Pit: Distance to nearest well___ _ _________._ _Distance from foundation--------------------Distance to nearest lot line-------.._____.._ + v [❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------------------..Depth--------------------------------- 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[_.__`___.__.-__-------________...___.f: f ❑ Distance to nearest lot line------------------------------------------------------------------•--••--------------------------------------------------------------------- '. Remodeling and/or repairing (describe):---------------------------------------------------------------•------------------------------------- i ---------- --- - - ---- -- ---- - ------—---p-------------.---pp----------------------------.-----------------_---------.-----------------------------------.------------------------------------- I herebycertifythat I have prepared this application and that the work will be done in accordance with San Joaquin Coun " ordinances. State laws, d rules and regulations of the San Joaquin Local Health District. {Signed} -'--- - --• ----------- -------------- {Owner and/or Contractor) y B Y•--- --------------------------------,------.,:_- -- - - - ----------------------------------------------------------(Tit e)------------------------------------------------------- --- (Plot plan, showing size of-14,71"cti"03 �f system in-relatio"o-wells, buildings etc.,-can_be;placed•on reverse side). FOR DEPARTMENT USE ONLY ?: APPLICATION ACCEPTED BY-- - ------------ ------- -------------- ---------------•------------------------ DATE_ _ Yr { REVIEWEDBY--------------------------------------------- --------------------------------------•---------------=----------------------- DATE------------------- - ' BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------• DATE------------------------------- ---------- ---------- Alterations -------- tAlterations and/or recommendations:--------------------------------------------- -----------------------------------•----•-•---------------------------------------------- ------ -•-----------------------------•-------------------------------------- ------------------------------------------------------•---------------------------------------------------------------•------------------------------- -----•--------------------- ------------------•---------------------------- ------- •---------------------------------------- --------------------------------------------------•--------- ----------------- ---------E --------------------------------- --- - -------- ------------------------ -----------------------------------•------------------------------- ------------------------------------------------------- ----------------- i FINAL INSPECTION BY:- _ ----------------- ------------- Date____..__ SAN JOAQUIN LOCAL HEALTH DISTRICT F 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.