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'r APPLICATION FOR SANITATION PERMIT Permit No. ..1..z ...?.�.. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is h reby 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. J08 ADDRESS AND- �OCATPN_ r ----------------- Owner's Name - -- -- ----- -------• f Phone. Address ----- ------------ k-... . - ----------------- ---- -- - Contra tor's Name _. == ------ Phone -- ------ ------- -------- Installation will serve: Residence ❑ A artment House ❑ Commercial ❑ Trailer Court ❑ Motel Other Number of living units: __/___ Number of bedrooms ----/_ Number of baths __/___ Lot size ............................... Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hard pan•❑ Previous Application Made: Yes ❑ Noo New Construction: Yes No ❑ FHA/VA: Yes ❑ No-pq TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) Septic Tank: Distance from nearest well-_5.�4-___Distance from foundations __ ._ �+ ,- - _ .Mate- riai_____ No. of com artments__�------------------_Size_ ---Liqui epth—&1_1--------------- _Capacity---- _ Disposal Field: Distance from nearest well -__Distance from foundation_ 1_ Distance to nearest lot Number of lines------Z----------------_ Length of each line______ _ ---_ F._______._.Width of trench.. - __-__-_._-___.____.____ Type of filter material___ _ _.__Depth of filter material__ �r Total length___.___ -------------------------- 'o"' __.____________________ f[ - /_�� / Seepage Pit: Distance to nearest well/pie...........Distance from undation ______ .__� Distance to nearest lot line---��.___-__ Number of pits._.__l--------------Lining material ___.Size: D meter._. - {_-_____--Depth_____r. .___ Cesspool: Distance from nearest well-----------------Distance from foundation._.__________.-----Lining material----__._._.___._________.____'_r____. ❑ Size: Diameter---------------------------------------Depth------------------------------------ - -------------Liquid Capacity----------------------------9 Privy: Distance from nearest well ____-_______________________Distance from nearest building--------------------------------------- ❑ Distance to nearest lot line---------------------------------- ------------- r-------------••------------------------------------------------ modelin anor pairing describe ------------'--------------------- --•--------------------- ;d ----- ----------- ------- ----------- ---------------------------------------------------- -------- t` - . -- - .�t --- ------------------------------- -- - I hereby certify that I have repared this applic i n a � that t e work will be done in accordance with San Joaquin County ordinances, State laws, and u s nd r ula ons o e San J aquin Local Health District. (Signed)--- _ � -- - =ct - - _(O and/or Contractor) M plan. I a#i- � -------------- (Title - --------------- (Plot p sh i , I on system in relation to wells, buildings, etc., can be placed onv s ree side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- --_ DATE------------------------ REVIEWED BY----------------------------------------- -- ---- ---------- DATE---- -_----�� ;- - �r BUILDING PERMIT ISSUED------------------------------------------------------------•----------------------------------------- DATE.---------------------- ------- ----------------------- --- Alterationsand/or recommendations:-------------- ------------------------------- -----•-----------------------------•---------- --------------------------------------------------------------- ----------------------- ------------------------- --- --•----------------------------------------------------------------------------------------------------•--....-------•--•------------------------------------------- --------------------------------------------------------------------- ------------------------------ _----- - --- ---- ------------------------------ ----------------------------- FINAL INSPECTION BY:.........ee - ------- Date------------ 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.