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APPLICATION FOR SANITATION PERMIT Permit No. f 'f' (Complete in Duplicate) �"�' Date Issued �5-`�___ Application is hereby made to the San Joaquin Local Health Districi` o4r afpermit to construct and install the work herein described This application is made in compliance with County Ordinance No. 549 }, r / JOB ADDRESS AN LOC O / 15�71� -yam = �' Owner's Name - :-- -- : �-- w Address___ __-__ �' 1 - : ------- --------- - -� - �'--- Contractor's Name �� ------- Phone- - ----- - Installation will serve: Residence Ap rtment House ❑ Commercial ❑ Trailer Court l] Motel' El Other ElNumber of living units: .- Number of bedroomsn,.-_9__ Number of baths J--- Lot size Water Supply: Publics stem Community system f Y � y y ❑ Private ❑ Depth to Water Table��ft `' 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob�g Hardpan ❑ ', Previous Application Made: Yes p No'r'K�—New Construction: Yes No ❑ FHA/VA: Yes Ej NQ.J�f TYPE OF INSTALLATION AND SPECIFICATIONS: ] f (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) ptic T k: Distance from nearest well______•;'1'1iDistance from foundation____________________Materia§__f--___--____________-______ =-------------- No. of compartments--------------------------Sizer----------------------- _-Liquid depth------------------- Capacity - Disposal eld: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_._________-_-- C Number of lines-------1--------------------------Length of each line------------------------------Width of trench--_--------------------______---_-- l Type of filter material______________________D.ep'+h of1filter.material-------------------- _Total length___-____--______________________________._ Seeps e Pit: Distance to nearest ell er ----Distance from f ndation _.Distan e.to nearest lot line pits------ ------__Lining malarial _�k +""-} " . Number of its__________-_ __.Size: Dia eter--- - "_-_ ___ .____.Depth___--- Cesspool- Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.__._____._________ -__-- ❑ Size: Diameter------------------------ ------------Depth--------------------------------•-----------------.-Liquid Capacity----------------------------gay Privy: Distance from nearest=well____-..___------------------------Distance.from nearest building-----.._---_-______________-_-__________.V` ❑ Distance to nearest lot line--- ------------ ----- ------------- -•- ------------------------ �.. Remodel- repairing cl scribe :___ f --��- • l ---- -------------------- -------- --- --------------------------------------------------------- _- --- _'_-- ---------------- --------------------- ----•-----.- . - - ---------------------------------- -------------------- --- --------•---•---- ----•------------- -------..._.._ r I hereby certify that I have;prepared.this appli ation a fha# he work will be done in accordance with San Joaquin County ordinances, State laws, d rules d cfulations the S �Joa in Local Health District. (Si nedlJ� 9 ]-��-- -- -- �-- --�-�=- -- -----r�-�'„� �-- -----------------(Owner nd/or Contractor) BY=----------------- ---- ----- � l... -- -_- --- --- - --------------(Title ---- �J- -- (Plot plan, sho to ize lot, locatio of sys+em'1n relation fo wells, buildings, etc., can be placedio, eves a side). F FOR DEPARTMENT USE ONLY ' APPLICATIONACCEPTED BY--------------------------------- ---------------------------------------------------------------- DATE----------------------------------- �. REVIEWEDBY- ."s� ---------------------------`-----------:-------------=----------------------- DATE------------------ - -------------------- BUILDING PERMIT'15SUED-------'-------------------------------- --------- DATE--- = - -------------------------------- Alterations and/or,recommendations:---- ------------------------------------------------------------------- ------------------------•----•---•---------------- -------------- --------------- I------------- ----------,------------------------------------------------- ----------------- ------------------------- ----- --------------- "". --------------------------------------- •.' -.._._ - -- - ----- --- }-4--- -------- ------------ _7-------- -------------- ----- - - - ----- -------- -----------------; - - ---------------- ------------------------- FINAL INSPECTION BY:------ - - ------- ate------- -------------- 7 ---------- SAN JOAQUIN LOCAL ALTH DISrkICT/\ N 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.