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APPLICATION FOR SANITATION PERMIT Permit No. [Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to constr U in al�h J�rk herein described. This a plication is made in compliance with Count Ordinance No. 549. JOB ADDRESS AND LOCATION_.___.___. -�-,� �i� Owner's Name---------- -•-------- _, _.. -------------------------- .t_j-� - Phone-- hoe . Address - --------•---------� . `------- Contractor's Name_ _ _ -•-- ----- •-•------------•- ---------------- Phone = Installation will serve: Residence EX Apartment House [3Commercial ❑ Trailer Court L] Motel ❑ Other ❑ Number of living units: r Number of bedrooms ._._-_--�/ Number of baths -------- Lot size � Water Supply: Public system ❑ Community system ❑ Private Ek Depth to Water Table _ w''ft- ------- --------- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam & Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ y` Previous Application Made: Yes ❑ INo �' New Construction: YesX No ❑ FHA/VA: Yes ❑ No EX ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E Septic Tank: Distance from nearest well-__7_'G---Distance from - foundation_______/a _Material____ _______•No. of compartments_______ A _ ______ r ---- --- X- ._Liquid � depth___------�`•_. e Disposal Field: Distance from nearest well__-� - .--.Distance from foundation___----7..w------Distance to nearest lot Number of linesY_______Length of each line------- ------Width of trench ---_" v r Type of filter material______ G- Depth of filter material---! -__? -- --------- -------- en ----------- _ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line_________________ ❑ Number of pits----F-.________----_-Lining material-----------------------Size: Diameter.---------------------Depth--------------------------------- F-1 - ' --- --- -- Cesspool- Distance from nearest well_________________Distance from foundation_____..____-------- I .Lining material----- -------- ---------- ---------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----- Priv -----------gals. Y . Distance from nearest well --------------- - ---}_-Distance from nearest building ` - Distance to nearest lot line----------------------------- � Remodeling and/or repairing (describe)---- --------------- -----------•--------------------------•--------------------------------------------------- ------ --------------------------------------- heti -----------------------------------------------------•------------•---------------------------------------------------------------------------•------------ --- - - ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, and rules and ulations of the San Joaquin Local Health District. (Signed)---- - -- -- ----------------- --- ------ - ----------- (Owner and/or Contractor) By:-----------------------------------•---------- k (Title)--------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY________ _- -------------------------------------- -------------------- -------------- - DATE._ REVIEWED BY ---------------- - --- -- --------- --------- --------------- __._ DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------- --------- DATE--------------.__-._ Alterations and/or recommendations:_-_ _________________-_ .-. ......____.-__-------------------. ------- --------- ------------------------- ------- ---•-- -------------------------------- --------------------------- - ----------------- -- ---------- -- ------------------------------ ---------------------- -------- ------------------------------------- --------------------------------------- FINAL INSPECTION BY_______________ __ __• _-----_ -------------------- ---------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.