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0 Permit No. --------- APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Issued a ------- -- -• Application is hereby made to the'San Joaquin LocalHealth District for a permit to construct and install the work��Ri described. This application is, made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- Phone Owner's Name ti°----------------------- ---------- --------------- ------------------------------------ ---`�' -r` ----- ` ---------------------- Phone-- l �f Contractor's Name_______--�}-�----- --- - - f Installation will serve: . Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -.____ Number of bedrooms -------- Number of baths -------- Lot size _________ _____ Water Supply: Public system ❑ Community system E] Private Depth to Water Table 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: Yes ❑ No X New Construction: Yes ElNo X FHA/VA: Yes E]. No TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) .-�.. - -. Sep i 'Tank: Distance from nearest well-_--_--- Distance from founds ion__. _ Material_.__.__��ezM'e ----- : ZIFIr Capacity.. �� No. of compartments___.__.'------ ---Size---- -----.-- E-�•�----Liciuid depth--.--�'Yx---- - -�---- X r Dispo Field: Distance from nearest well _-.--_----_--Distance from foundation-./--O---_.__._.Distance to nearest lot lin��__�-`. Number of line's-----,.__f--------..___._.____3 Length of each line._____. ----- Width of trench. s - N Type of fines',material-----R.0-Cl __.:-Depth of filter material:._.Af__.---------Total length-5____ ---------------------•---- o f1 Seepage'Pit: ,. ... 'Distance to nearest well'----------------_ Distance from foundation___-----_-..__--___.Distance to nearest lot line.______.____...._ � l ----- Number of pits- ----------- ------Lining material-------- ------------size: Diameter--------•-----�--,----- apt --------- - at El a Cesspool: Distance from nearest well--------------::_Distance from foundation---------------------Lining material--______-- -------gals+. I ❑ Size: Diameter----- --------------------------I---Depth--------------------- - ----------- Liquid Capacity Priv Distance from nearest well-----.-�-------------------------------------- --Distance from nearest building.--------_---------------•---------------- Y' _ w --------------------------------- ----- ❑ Distance to nearest lot line-- ------------- - -------------------------------------------------- Remodeling ------------------------- -- f Remodeling and/or repairing (describe) - ------------------------------------------------ -_--------------------- - ---- ------------------------------------ -------------- -------- - to ----------- ----------•-----------------•------ ------------------- - ---.----- ------ - - -- 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, an r leis and regulat' s the San Joaquin Local Health District. " 1 --------(Owner and/or Contractor) (Signed)- --- --------- / -- - - - -- ---------------------•----------------- ---------------(Title)----- ------- -- --------------------- (Plot plan, showing size of ot, location of system i . elation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY r•--L- APPLICATION ACCEPTED BY----------------------------� ---- ---- --- - - -- ------- --- -- ------------------ DATE---------�---�---L---- J--- ---------------- DATE-----�-------------------------------•----------•------- REVIEWEDBY------------------------------------------------------ :- DATE------- ----------------- -----------------•--- BUILDING PERMIT ISSUED----------------------------------- ---- ----- ---------- ------------- --------- ---- ---•---- Alterations and/or recommendations:--------------------------------- ecommen a+ions:_________________________________ ----- ----------- ------------------------- --------- ------•-----•-------------------------- ----- - ---------------i----------^..-•--------11 -----------------•----- ______________________________________________________________ _ ________________________ ____ _. ._ __ ________________ ___ • ______ --)---o---__ . FINAL INSPECTION BY:---- ' -----P-------: -------- " Date_.._i5- _ r- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Weit Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES--9-2M . Revised 1-57 F-PCO.