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APPLICATION FOR SANITATION PERMIT Permit No. ..... }.11.! (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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND C ON____ -----�5i?,-eZ -------- ,_--___-___-- Owner's Name ------- --------- Phone rr,,��,, ----t Address----------- ---c ------- --• ---- -Q Contractor's Name----------- ------n ------------------- -- --- - -------------------------. Phone---------------•--•-- Installation will serve: Re dente [-ApartmenfrHouse ❑ Commercial,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Numb6rof bedrooms___Number of=baths -)--- Lot size ____�_l2__ Water Supply: Public system Community system ❑ Privatetj�De,pth to Water Table j:Yft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application .Made: Yes ❑ No New Construction: YeQA� �No ❑ FHA/VA:.Yes ❑ No NK TYPE OF INSTALLATION AND SPECIFICATIONS: - W (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTank: Distance from nearest wel{- ---Distance fr`{��,�,f,'n foundation__._ �.�—___-Mat er'af_ _________-4.______._� ____ . No. of compartments----------�----_-size x--[__O - ' ' Liquid d pth , Capacity ' _.. i : Disposal Field: Distance from nearest well__ _.Distance from foundation___�__ _-_______Distance to nearest lot f inei_i____ _-_____ liz Number of lines-------'ai---------__________. __Length of each lne_ �J__®_' __ - .Width of trench.:_T"_s____.___---__-____- - er, .. Type of filter material__'__-Ir Depth of filter material____.-----------Total length_______. --------_ ------------- Seepage Pit: Distance to nearest,well-----------_----------Distance from foundation--------------------Distance to nearest lot line___________.__.-. ElNumber of'pits_:______---!:h--_F�Liing material______________________ ` � n� .Size: Diameter-----------------------Depth--'----------- ----------------- Cesspool: Distance from nearest well------------------Distance from foundation------_____---------Lining material _.__-__?----._____._ ------------- ❑ Size: Diameter ------------------ aci i -------.Depth------------------- -_-------------------------------Liquid'Capty'`^•-----. -g$Is. 14 - Privy: Distance from nearest well__ f---_____--------------------------------Distance from nearest building__------_________________-_ --------------- ❑ Distance to nearest lot iine____..'________ Remodeling and/or repairing (describe:_-___.;�. �7 --- •- d Ct.r .Q,�_�¢-tt�:_ _ 4 ijounty ----------------------•---------------------------------------------------------------£-------- -------'---------- - r------- ---------------------------------------------------------------________-.__.______--------- ----- --- --_-----------------`----------------------------!--------------------------•---------------------------- 1------------------•------I------------------Iherebycertifythat I have prepared this application and that the work will be done in accordance with' San Joaquin C ordinances, State lawt, and rules and,�regulations;of the San Joaquin Local Health District. M (Signed)---------- - - ---------------- �- ------ -- --- '. --------------------------------------( rvand/or Contractor) By: .�" (Title) � " " h _ _ __ __ �__ ... $a`__ __ ________ ___________________._. [Plot plan, showing size of lot, to ,tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------------------------- ------------------------- DATE----------•------ f REVIEWEDBY------------------------ -------------------- ------ ------- ------ DATE BUILDING PERMIT ISSUED_ ------- -----------------------------•------------ DA•TE---- ----- ------------------------------ -------------- Aterations and/or recommendations___________________________ ------------------------- -----•-----------------•------------------- ----------- ----------------------------- ------------------- --------- --------------- . k ----------------------------------------- ---------- -------------- ------ ----------- -------------------------- FINAL INSPECTION BY------------ --------------- ------- ------- Date-------------- ----- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Calc Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California �� M Tracy, California y ES-9-2M Revised 8-'59 F.P.Co.