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APPLICATION FOR SANITATION PERMIT Permit No. -.If permit (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 and install the work herein described. This application_..is m ade in compliance with Co--u--n--t--y- Ordinance No. 549. ---- - - --------Q---O-- -------- rf � ------ D S 7_, JOBADDRESSAND'LOCAON - ---- �- --- Phone ------------------------- - ----------------- ------ -- Owner's -Owner s Name-- - - ---- ----- --------- Address__________ _ ____ - - ---------------------• --------------------•-----------------.--•--- ---------- --------------------------- --------------�� Phone----------------------------------- Contractor's Name--- -----•---•-------••---------------••--------••--------- -- - Installation will serve: Residence 21 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f ________________ I-V' Lot size Number of living units: __�----- Number of bedrooms -_�-- Number of baths + Water Supply: Public system ❑ Community system ❑ Private JA Depth to Water Table .,3q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No j�® FHA/VA: Yes E] No [ITYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Septic Tank:. Distance from nearest well_________________Distance from foundatioin uid de }h Material__--- -- Capacity_______-____" _____. ❑ No. of compartments------------- --------- --Size--------------------------- q p Disposal Field: Distance from nearest well--- Distance from foundation___._- ----.--Distance to nearest lot line -S__-•---• Number of lines___.____"- __ Length of each line_____..-4"""--------------Width of +rench----'),4-'.)------ ------------------- 19 Type of filter material" 04-Depth of filter material____ -y------------Total length___--- "�-- See age Pit: Distance to nearest well__" """-----Dis# 01 anc�ef r m foundation-_ZU_`k.__..Distance to nearest of line-- materiaSize: Diameter___, ---.-.- - ---Depth_-_-_... Number of pits----�--------- -- g "- 6 I-- Cesspool: Distance from nearest well-----------------Distance from foundation ----------------Lining material_____------"--------"""---- -"-gals. Depth --------------------------- Liquid Capacity- ❑ Size: Diameter-------------------------------------- p - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ p" Distance to nearest lot line__________________________----------------------------------------"--- Remodeling and/or repairing (describe ------ ------------------------------------------------------------------ ------------- - J ----------------------------------------------------•--=------------------------------------------------- - ---cor th San --- ui , done I hereby certify that I have es prepared this application the Sand that the oaquin work o kHeallth District. accordance with San Joaquin County ` ordinances, State laws, (Owner and/or Contractor) (Signed)--- ---`-- ---`----- - - - --------- --------- ------------ ----------------------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1- ..°----------------------------- APPLICATION ACCEPTED BY_ ---------------------- DATE---------______""---- REVIEWED BY-------------------------------------------- --------------------------------------------------------------------------- DAT E----------------------------------------•------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- --------- ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------------------- /,Z — .e ' - - ----- FINAL INSPECTION BY:__..t ------------ Date. . � SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street $14 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Rev�sed 6-'59 F.P.Co.