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APPLICATION FOR SANITATION PERMIT Permit No. . .....----f--.-=--- (Complete in Duplicate) Date IssuedThis 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. ------------------------------------------------------ _ r -------- ------------------------- JOB ADDRESS AND LOCATION Phone------------------------------------ ------------ Owners Name___ , __. - ------------- ----------- -- --------•--Address one----------------------------------• Contractor's Name___r��.� ��-�=' "-----•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial JP Trailer Court ❑ Motel ❑ Other ❑ _ __ Number of bedrooms -_1-_._ Number of baths I_ Lot size ---" -- - ----------------------------------------- -------------- Number of living units: _1 - Water Supply: Public system ❑ Community system F1 Private M Depth to Water Table 3D._ {#•; ! lardpan E]Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [I Clay ❑ Adobe❑ Previous Application Made: Yes [3 No � New Construction: Yes No ❑ FHA/VA: Yes C] No El TYPE.OF INSTALLATION AND,.SPECIFICATIONS: — --- — f � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1_. .. Materiai-- ----------------------- Septic Tank: Distance from nearest wel4_�S-7--__Distance from foundation___0--- ------ Ca aci R .� ----- i - I ly No. of compartments_.."�"-- -------------Size 7 --- ---L- Liquid depth p tY Dis osal Field: Distance from nearest well: �--------Distance from fo dation. -`� --Distance to nearest loft line_________________ -Length of each line__"___s�D--- --------- -Width of trench-_36e, Number of lines g "' oral len th__ 4'-------------------------------- Type of filter material _ _ --Depth of material___._1 --- T g """ Distance to nearest lot line_________________ Seepage Pit: Distance to nearest well__"___________________Distance from foundation_____________ Depth El Number of pi#s----------------------Lining material-----------------------Size: Diameter---------------....- Cesspool: Distance from nearest wei---------------- from foundation___________________ Lining material----------------------------------- Size: Diameter--------- ------- ----'-- - p ------De th----------------------------------------------------Liquid Capacity-----------•---------------g El Privy: Distance from nearest well_________________________ Distance from nearest buiIding------------------------------ ---------- Privy: Distance to nearest lot line------ --- ---------- ----------------------------------------------------------------------------------- F1 , 1-�^"- -'" ------------ ----•----------------•-•-------------------------------- zb,k " - - Remodeling and/or repairing (describe):___._,-- ----------------- ------- ------------------------------------ ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sang Joaquin County ordinances,jSt01aws, d rules and regulations of the San Joaquin Local Health District. j ti Qwy_ r.and�or ContractorlSi ned ---- .--� -- _-- --., . „� - ( 9 } Y., - -- ---- ------------------------------------------------ BY -------- -- � (Plot plan, showing size of lot, location of system inrelationto wells, buildings, etc., can be placed on reverse side]. i FOR DEPARTMENT USE ONLY � DATE---�-� ----��------- -------------- -------- APPLICATION ACCEPTED BY-- - -------- --------- --------------------------------- --------- -- DATE-------------------•-------- -----•---------------------- REVIEWED --------- ---- REVIEWEDBY----------------------------------------- ----------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------- Alterations and/or recommendations-----------_-------------------------------------------------------------------------- ---------------------- -------------------------- ---------W----- ------- ---------------------------- FINAL INSPECTION BY: 1 Date---- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y' ES-9-2M Revised 8-'59 r.P.CO