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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 and install the work herein described. This application is made in complian*wf' Voudire No. 9. / O L r A j E JOB ADDRESS AND LO TION... ` ? Owner's Name -----•--- ----------------------------------------- --------------------------------;------- .... Phone..._.. Address- J. 4 ------- �. .- --------•-------=---------- -------------- ----------.------------------------ ------------- -- - -- -- Name---------------- 6------ - ----------------------------------- Installation ------ ------ -----••-------_ = == Phone..--------------------------------- Contractor's Installation will serve: Residence ®�partment House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ nOther F1Number of living units: - .-: Number of bedrooms _- Number of baths _/_- Lot size -../-- d� - - _1------------------------ Water Supply: Public system �ommunity system El Private F1 Depth to Water Table _��i�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D Clay.[] Adobe (�ardpan ❑ Previous Application Made: Yes ❑ No Ur-""New Construction: Yes �No ❑ FHA/VA:•Yep 9-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) . 777 I� .-....Material,, _ . Septic Tank: Distance from nearest well........ ...Distancg� rom/foundation..... __. _. .---------. p No. of compartments.�,�...-....__--Size. . - � ---Liquid depth..--12( ------------Capacity...--� ._ ' Disposal Id: Distance from nearest well....-- -.-----Distance from foundation_-_-/V------.Distance to nearest lot lia,. V�.. Number of iines.:....... ... .. _. ..._.... _Length of each line----- -.---.-..-.-...Width of tranch.....- ......-._._--..._.. t / e" Type of filter mat eriaLl -_ Q .__Depth of filter material_._ - -.�f.-.....Total length_--...... _V �� Seepag it: Distance to`%earest well----- .Distance from foundation..__�4..-...Distance to nearest lot line-J.��___..... Number of pits ----/.------- g�... - c Deptn__440� j------------ lip ..Linin mafe�al._.. . Size: Diameter.- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter.-----.-------------------------- --Depth---- ---------------- - ----------------------Liquid Capacity----------------------------gals. r Privy: Distance from nearest well ......................_------------..........__Distance from nearest building.----------------------------------------. Distance to nearest lot line --------------- ----- ------------- Remodeling and/or repairing (describe):----------------- :�� : u-... .. .� ------- --------------------------------------------------------------------------------------------------------•------------------------- ----------------------------------- ---------------------- -----------------------------------------------------`------------------- ---------------------------•---------------------------- -------- I -- - ; I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---------------- :--------------------------. Contractor)(Signed)------------------------------- v BY:------------------------------------------------------- --- --------- ----------- --(Title} o ' ------------ (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY- 1 APPLICATION ACCEPTED BY-------.�1_K�o---------------------------- -------------- ------ DATE---- / - ------ ---------------------- REVIEWEDBY--------------------------------------------- -------------------- ---------------------------------------------------------- DATE-------------------------------- --------------------------- BUILDING PERMIT ISSUED---' — --------------- DATE------------------------------------------------------------- ----- and/or recommendations:--------------------------------------------------------------------------------------------•-••------------------------------------------- --------------- -------------- ------------------------------ ------------------------- ------------------------------•---------------------- -------------------------------------•---------------------------------------------- -------- ----------------- ----------------------- -------------------------------------------------------------------------------------- ------------------------------------------------------------------ ----------------------------------- - FINAL INSPECTION BY: ------ Date.- ----/ - -- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street d 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California t$ ` Mlan+eca, California Tracy, California a ES-9-2M Revised 6-59 F.P.Co.