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APPLICATION FOR SANITATION PERMIT Permit No. ..�(Complete in 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 compliarice with ounty Ordinance No. 549 w - --- --- ---- JOB ADDRESS AND LOCATION � _ Phone -------------------- 3 - _ -------Owner's"Ndffe - 4f---------- ------- ------ Contr`actor's Name---- -------o -- Phone Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court El ❑ Other Number of living units: --�-_' Number of bedrooms -3- Number of baths __-1-_. Lot size _--_- ._'k - ----- ---------___---------------------- Public systemCommunity system ❑ Private Depth to //Water Table . Water Supply {y r „�� . 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: YesXNo ❑ FHA/V : Yes ❑ NoLIZ TYPE OF INSTALLATION AND SPECIFICATIONS: // \\ '(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance fro fours tion---/D--------,lyla�eria ------------------- -------------------------- Septic ,Tank: Distance frorrAearest well- C 1 _ `!7 No. of compartments------------- Size-3-3(----------- --_Liquid depth------f -------- Capacity --__ / 7"} 1- -_-_-.--Distance to nearest lot line -------- Disposal Field-. Distance.,from,,nearest well-/0-Q"�Distance from foundation--- _ �{ f Length of each line---_ _Width of trench-` - _, Number of;lines---•-•.��-------------- - -- g ��+�----�c-7- ------ Type of filter mate'r�al_ �Depth of filter material---/ ---------Total length------ --------- /S� ------------------ Seepage Pit: Distance to nearest well___-------.__-.------Distance from foundation-�1 ---..-�__..Distance to nearest lot line-------------- ❑." Number of pits----------------------Lining material-----------------------Size: Diameter---- �: .......Depth--------------------------------- Cesspool: �y Distance from nearest well-----------------Distance from foundation'_`_._-__-.---_-.Lining material--------------..__----------_-----_- ❑ f `Size: Diameter-------------------------- ----------Depth------ --- - ------------------------------------------- Capacity----------------------------gals. Privy: Dis"fncE from nest well-______---_----.-__---------------------------Distance frorrr nearest building------------------------------------------ Priv) ------------------------------------ --- Disttaance:,t i-kadre� lot line--------- ---------------------------------------------=--------•----------------------------------------------------------------------------- Remodeli g aid/or.,repaiinl (decnbe): { - - -- ----I-------------------------------------------------------------------------------------------------------- ------ I ------------- ------------I------------------------ -------------------------------------------------------------------- ----------- -----------------------------------I--------------------------------------------------- e 1 hereby certify that I have'prepared this application and that the work will be done in accordance with San Joaquin County ordinances,ISIalaws, and rules a regulations of the San Joaquin Local Health District. (Signed). 4 x -------------------- ---------------------- (Owner and/or Con#tactor) --- ----------------- -- --------- --- -------------- It e !By-------------------- (Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side). € k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-----._-___._ DATE------------ --------------- -_ -- -- -------- ----- REVIEWED BY DATE.----- ------- ---------- ----- BUILDING PERMIT ISSUED------------------------- DATE Alterations and/or recommendations-------------------------------------- ----------------------------------------------- - ---------- ------•----------- - - ------------------------------------------------ ---------------------------------------------------- ---------------------- ---------------------------------------- FINAL INSPECTION BY---------- ----------------- ------- Date------------- Hca �'� �5:-- ------ ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stroe+ 300 West Oak Street 132 Sycamore Street 814 North "G" S+tea+ Stockton, California Lodi, California Manteca, California Ttacy, California ES-9 2M Revised 8-'59 FY Co.