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APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) This Permit Ex fres i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr This application is made in compliance with County Ordinance No. 549. uct and install the work herein described. Dsrp . - --3 JOB ADDRESS A .------ ND LOCATION Owner's Name ' � Phone..-_...-----•-------------- u rte- �--------------••--- -------------------------- Contractor's Name _ _- -------- ---_ _ -_ .- -•-----•----•-----------------•-------- - - -------------- Phone.. Installation will serve: Residence 30 Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other Number of livingunits., _J_--:_ Number of bedrooms --_ ❑ �._ Number of baths _.�-- Lofi size --"-f Water Supply: Public system --�------'----�---�"- PP y y ❑ Community system K Private ❑ Depth to Water Table -74! ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes I] No ❑ New Construction; Yes No ❑ ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or.cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well_-/-`�P.....Distanco from foundation_Z9----___ - Material No. of compartments--- ---------- ----Size- `-------Liquid depth----V 1'.--------------Capacity p Number of line's---- 9 nj� french-. ,� S is osai Field: Distance from nearest well./__"--.__--_-Distance from foundation------------------- ------------ -___"--- Length of each line---_ Widthcoftfre ch.nearestlotlane. "" _ Type of filter material Depth of filter material_-- -l_ 10V------------Total length---1 Z O 1 ee ge Pit: Distance to nearest wel--- '_ . - -__-Distance from foundation___. 0- -..,Distance to nearest lot fine-_ �__oi- Distance Number of it's--_ Lining materia p Size: Diameter _1; 11----------Depth_.�'gesspool; from nearest well-_- __Distance from foundation------ ---------Linin material___-.-----__-_---_-------._ ❑ Size: Diameter--------------------------------------Depth--------------------- ----- --- -- -----------Liquid Capacity-- ------------ - - - - - -------------------------gals. Privy: Distance from nearest well-----------_-------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------ ------------------------------ Remodeling and/or repairing (describe):_- -------------------- -----•----------- - ------------------------------ ------------------------- i --------------------- -- ------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- --- ------ -----(Owner and/or Contractor) l By:_-------------------------- --------------- - - —�- ------ - - -------------- ----- -- - - --------------------------------------------------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed onryreverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY- ------------------------------------------------------ -O t? I REVIEWED BYDATE f---------- ---------------------•-- - ------- DATE-------- --------------- -------------------------- -- UILDING PERMIT lSSUED----------------------------- ----------•------------------- -- ------------------- ---- ------ DATE------ - ---- -------------- - ------------------=------ - Aterations and/or recommendations:--- - -------------------------- ------ ------------------------ ------- FINAL INSPECTION }�- � 1_._.- �- Date---------/-_J Q_ ---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streot 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P,Co.