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APPLICATION FOR SANITATION PERMIT Permit No. (Comple+e in Duplicate) This Permit Expires ] 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 Count Ordinance No. 49. JOB ADDRESS AND OCATION-._ ____ j- Owner's Name-.__.._`7- ---" `--------------- --------------- Phone----------- ress------------------- Contractor's ---------•-•------ - --------- ------------- ----- •------------------------------------ Contractor's Name /Y i� /� �% --- ------••---------------------• --------•--- Phone Installation will serve: Residence ®"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel`❑ Other ❑ Number of living units: __�--- Number of bedrooms f Number of baths __1.- Lot size _ ---__ ,�---------- ------------ Water Supply: Public system ❑ Community system ❑ Private eptli,ao Water Table ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑. Sandy Loam ❑- Clay Loam Frl!lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes 0 No 9?" New Construction: Yes J?"�No ❑ FHA/VA: Yes P9`�_No ❑ F 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 Distance ffm -__,/--' � Maoun �tonte2ral----6_ nn _ - Q-----�------------ MOO �--- -- No, of compartments...__. ----------Size_ OXAA_ .Liquid deph---- �------------Capaciy---- Disposal Field: Distance from nearest well----W-,I)------Distance from foundation___q�Q ---------Distance to nearest lot line____-► ~_____ Number of lines---•------ ._ --- --- _--Length of each line-----I-Wr s Width of french-----09-. �i YP T e of filter material-,� - Depth of filter material.__.--� � ----Total length-------- _40e � ; Seepage Pit: Distance to nearest well____- Distance f m fo ndation--_ 4 , -�- - - � �.��.�..D� tan to nearest lot line___. __�__--- 1 Number of pits_______ _________Lining material__ s Size: Diamefer__.. Y_-.-._ Depth---. "�'- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------ material--------------------- ❑ Size: Diameter Depth ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well --------------- .-Distance from nearest buildin ❑ Distance to nearest lot lines.__....'-- ---------------------- --------------------------- -= r ----- Remodeling and/or repairing (describe]:_-------- -- +! _: --- -----------•------------------------------------------------- R --------------------------------------------------------- -------------------------------------------------- - ---------------------------------------------- - ----------------• -- -------------------------------------------------------------- - -----------------------------------------------------------•---------------------------------.°.___ 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. -------------`---- ------------- ontract (Signed)-----------------------------/"' orl1. By:---------------------------------------------------------- (Title)---- (Plot ------------- --------------------------(Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). 1 , . FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY-.__-_-- -_ - --- -- ------- - --�-------------- --------------- - --- DATE---=�--'-- - ---?---- -=- REVIEWED BYQ ' p ----------------- - DATE-,---------------------------=------------------- ---------;_ BUILDING PERMIT ISSUED 1 1T- -. f - ------��. ---- --------------- � -------._ ....... ---- DATE.-------------------- ------------- - - •Alterations and/or recommendations:------------------- T - ! --------------------- 4 ------ -----------------------------•--- a - I ------------------------------------------ I ----------- ---------------------------- ---------------------------- FINAL INSPECTIO �--- tiLDAte----- - ----------- ---.----- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 FY.Cc. q't