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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 applicafiori is made in corn •lance wi County Ordin nce No.,544,_ 46" 1-772— JOB ADDRESS AND LOCATI N-•••=••- ... ------------------- •'------- ....... _ ___---- Owner's Name.......... . ., .. . .. ... _,. _........_.... ................• Phone_........._......_._......... ._.._ Address•--- ......__..-. r-- - - r ............. -,-.... ......... _..... _ ...-...__..._. -Contractor's Name.---......._ -•.....:. _._._. ........................... .. ....... .•--•.. ._.._•-- ..._.. Phone .4= Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other aZez , Number of living units' ........ Number of bedrooms :______ Number of baths ........ Lot size .......................................................--._ t Water Supply. Publicsystem 2_11Commuriity system ❑ Private ❑ Depth to Water Table .5-0 ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy-Loam ❑ Clay Loam 0 Clay ❑ Adobe Hardpan❑ Previous Application Made-, Yes Ug"INZ ❑ New Construction: Yes Uf No ❑ FHA/VA:Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank•or cesspool permitted if public sewer is avahbla within 200 feet.) r Ta k: Distance from .nearest well_________________Distance, from foundation_._.................Material_..............._...................... _,___;,_^ No. of compartments Size....... •..••__.. ...:___Liquid depth -----------------Capacity_ ------_- �. Distance from nearest rr w-e�fJ� Y.� .Distance from foundation ,l j Distance to nearest lot line_.4d 4 ®' Number of lines---------!..P.........t.__ _._Length of each line.... .`a____;f_._.Width of french .-__. Type. .of filter material_'., __Depth of filter material-_./A........ length..............__ d_•.._._ Seepage Pit: Distance to nearest well.........-_.._......Distance from foundation....................Distance to nearest lot line................. ❑ Number,of pits ...:.............Lining material..•... .........Size: 'Diameter_._.,---------------_-Depth-............................... Cesspool: Distance-from neaiest well._...............Distance from foundation._.................Lining material_..-.................. ____.___�_:_. ❑ Size: Diamefer------------------------.............Depth........._.-......................................Liquid Capacity------- Y' building..,,",, - gals. Priv Distance from nearest well _-.Distance from nearest buildn ' ❑ Distance to nearest 'of line.......--------.......__......_. -____._.._._._.—_------_--_-• ___._._ -__-- - ----Remodeling and/or repairing (clescribe):_ - _ ....... _ ....... ---••- - - _ ................•._.----..•- ..- ... --.................._------------. .... .... . ... - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and r es and.cegulations of the San Joaquin Local Health District. (Signed}....-•---• . .- - - ...._. . • - ;._. == •--... ner and/or Contractor) By:.. -----------_.- >.,....-. _..-•- � •.... = (Title) .,r_------ ---- --------------------- lPlot plan, showing size of lot, location of system in relation to s, uildings, etc., can be placed an reverse stile). FOR DE-PAkF4ENT USE ONLY APPLICATION ACCEPTED BY -. _- - -.__._ ____"""`".. DATE ___-__-_____ _------ MIEWED BY............... DATE -----__-- BUILDING PERMIT ISSUED ____ -- __ _-----•---_--_------_--___..____.................. DATE___ ___________—__-_- .r,.__ Alterations and/or recommendations......____............ ------ .......-......... i f iNAL f,NSPECTION I 3 .... - / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soafh Amariwn Sheet 300 Waif Oak Sir** 133 Sycamore Street 314 North, "C" Street ' Stockton. California Lodi, California Manteca, CaGionila Tracy, Celifornis ES-9-2M Rc,ised 6-'59 P.P,Co. '