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�10 � ✓ r� M APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ' Date Issued _______ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct'end install the work herein described. This application is made in compliance with County Ordinance No. 549. JOBADDRESS AND L ATI N j -- ---- - - ----------------------------------------------------------:-------------------------------.... OwnersName_------- -- --- ------------------------------------------ " ---------------------- Phone-------------------------------- Address------------ .-_----------------------------Address------------ --------- L --)--- ----•- ----- ---------------------------------------I-------------------------------------------------------------------------- Contractor's Name---------------- •' Phone. Installation will serve: Residence Er-_'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 11� /' Number ofliving units: __l___ Number of--bedrooms _, _ Number of baths _/-__- Lot size _4' .._I --------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g3- ardpan ❑ Previous Application Made: Yes ❑ No 9?'0'_New Construction: Yes ❑ No 2`_ FHA/VA: Yes g?"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic jank, Distance from nearest well-----------------Distance from foundation--------------------Material---------------------------------------_.-._-___. No. of compartments- -------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- Dispo,sal Field: Distance from nearest well_ ____________Distance from foundation--------------------Distance to nearest lot line________._--_._.. 0S /4,f Number of lines------- ------Length of each line------------------------------Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- Seepage Pit: Distance to nearest well-----:f_-----Distance from foundation____� --------Distance to nearest lot line >1 ®11r Number of pits------_/------------Lining material__ 1� / ..Size: Diameter__3J'-r_...___Depth__..F+ _1________________ 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------------------------------------------ 171 Distance to nearest lot line------------------------------------------------ --------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------- f uc � --------------•-------------------------------------------------- -------------------•-------------------------------------------------- -------------------- ------------------ --------------------------------------------------------------------------------------------------------------------------------------------•------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r-�e,•,g�ul_ations off�the,San Joaquin Local Health District. (Signed)-------------------� . � _ --- - ` '"�" °J -- y _--TG ----------------------------------------- r Contractor) By:------------------------------------------ ----------- - ------------••-----------------------(Tit le)-- 1 ' (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------------- -------------- DATE--------- �� -�� APPLICATION ACCEPTED BY----- --�-�---`---------------- ------------- ------------------- REVIEWEDBY--------------------------------------------------- --------------------------- ------- -------------------------------------- DATE-----------------------------------••---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DA-TE------------------------------------------------------------- Alterations and/or recommendations:_.-------------- ------------------------------•----------------------------------•---------------------------- ---------------------------an------®e•----pr`r------3� -------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ----------------------- --------------------------------------------------------------------------•--1-----------------------._.....-------------------------------------------------------------------- -------- - ------ --------------------------------------------------------------------------- ----------------------------------- - FINAL INSPEC160. BY - - --- ---------- - Date _=.1 "1r2.4 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. -