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/ 1 � APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1 This Permit Expires 1 Year From Date Issued -y Date Issued •--__ __ X-a 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 LO ATION-_--__. _ - _-�-- Owner's Name------ ------ -•---------- ----------------- --- ---- Phone------------------------- Address---------- ------- --- ------------------------------------•-----••----------------------------- --- ----------------------------------- Contractor's Name ~------- ------------------------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�-�,�: Number of bedrooms Number of baths -_/--_ Lot size Wafer Supply: Public system Imo. 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�ardpan ❑ Previous Application Made: Yes ❑ No Z--""'New Construction: Yes ❑ No FHA/VA: Yes ❑ No [}� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se 'c Tank: Distance from nearest well--------------------Distance from foundation--------------------Material ________________.-.._________._..___..__._.___. No. of compartments'----------'--------------Size--------------------------------Liquid depth----- -----------Capacity Disposal ield: Distance from nearest ell__ __..._.Distance from foundation- -----..Distance to nearest lot line_��.-0_" ____Length of each line-_- �� � S � Number of lines-------�___-- � ----------Width of trench--s�� ___ _ ____ �f- Type of filter material , ---Depth of filter materiaL__l �!-___Total length__---�-.a _�..._ Seepage it: Distance to nearest well:..-.."---_---_Distance fro fou anon_ Dist nce to nearest lot line---�_---__ Number of pits----- ...____._I---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___.._.__-.-------.-____-----..-_...___..- ❑ Distance to nearest lot line--------- -------------- - -- -- ---------- ---------------- Remodeling and/or repairing (describe)_____________e., --- -- - ---- - •----------------------- ------------------------------------------------ ------------•------------------------•---•----------------•---------------------------------------------------------------------------------------------------------- I hereby certify that I }lave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and-`rules and regulations of the San Joaquin Local Health District. (Signed) --- ---- -- ---- -- ---- 9 )---------------- ---------( 1'or Contractor) BY: ---- ---- -- `�---------------------------(Title)----tS+�4.4,1 /.L-1,. .....-- -------- (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPA TM1=NT USE ONLY APPLICATION ACCEPTED BY----------- ------------ DATE-------- -_�- ----------------------- REVIEWEDBY-------------------------------- -------------------- - ------ ----- ------=------------------------- ----- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------•-------`------------------------------- DATE-------------------------------- ---------------------------- Alterationsand/or recommendations;----------------------------------------------------------------------------------------------------------------------------------•------------••------------- ----------------c-------- - - - - - - - - .z� ---e-------- - --------------------------------------- - -------------------------------------------I------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY:..------ K ---------- Date-----------------C � ------------------------------ ' SAN JOAQUIN LOCAL-HEALTHI DISTRICT,. ' r sa. 130 South American Street 30D 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.Cc.