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APPLICATION FOR SANITATION PERMIT Permit No. ............. ......... ..:." 6 (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 compliance with County Ordinance No. 549. ,qtr � JOB ADDRESS AN LOC,3TION_Lz""_ _l__,P. t' -` `� 1 ` �_: �__. .. ---------- - Owner's Name �- t t Phone_ .. ---------- y r� r!t. Address .- ,.----- fw. {-R-'------------------------------------------------------------------------------------------------•---------------------------- Contractor's Name---- -- ------ --------------------•-•---%�-------------------------- --------- -------- -----------•-------------------------------- Phone----------------------------------- Installation will serve: Residekte Apartment House Commercial Trailer Court Motel 0 Other Number of living units: ---k--_ Number of bedrooms _ Number of baths -1----- Lot size ._ ,.r��;� __ __�''`-._;-------- -------------- Water _-__. __-_Water Supply: Public system ❑ Community system EV Private ❑ Depth to Water Table __ 'f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 10' New Construction: Ye Y�'A No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public 7s'eis available within 200 feet.)Septic Tank: Distance from nearest well !' s#ante from foundation_-_ _ ..------Mat riaJ------------------------------------ ----------. - t �r*,. No. of compartments_.___` __A___________Size__,>as a. _a.____. ------- Liquid depth------ _ r - "_.__Capacity_(rata Disal Field: Distance from neart well Distance from foundation----./,-O Distance to nearest Ipt line. GA Number of lines__-.___. -_ L ngth of each line_ a`_ .t '� -)l " {th of tr nch. _: 5_ '__�r___,.. Type of filter material__ �:�----.'---- L , epth of filter mat r ,_'__,i. fZ . {o a_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-___-__-___.- ❑ Number of pits Lining material-----------------------Size: Diameter_____________________Depth--------------------------------- Cesspool: Distance from nearest well---------------._Distance from foundation------------------_Lining material_-__________________________-___.1771 O Size: Diameter_ ______________De th__-__--.-_--________---____-__-_______________.___--Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------- r Remod ling and/?r repaiping (descriU�r� - � QA r t y ter, _fil P � 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) BY:--------------------------------------------------------------- --------------------------------------f---------------------------(Title)-------------------------------------- ---- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------------------------------- ------ ----- ------------- -- - DATE----------------------------------- ------- --------- REVIEWED BY----------------------------------------------------------- --------------------------------------- DATE '"� a BUILDING PERMIT ISSUED----------------- -- .-- . r-------- ---------- ' -- DATE-- _ _--.-_-_- ----------- - ° Alterations and/or recommendations:----------------------------------------------- =---'------ - ------ -------------------------------------------------------------------•------------------------------- ------------------------------------------------------------ -----•--------- --------------- ----------------------------------------------------- --------•-------------------------------------------------------- ----------------------------------------•------------------------- -----------------•----------------------------------•-•-•----------------------------------------------------------------------------- ---------------------------------- ---------------------- -----------------------------•------ --------------------------------------------- -------------------------- --- ------------ -----•------------------------------- --------------------------------- ---- --- ---- ------- ------- --- --- --- - - -- - ----- --------- - - ------ --•- --- -- ---- - - - ---------- FINAL INSPECTION BY:._--.... -- - " ' Date ----------------------------- ! 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 F.P.Co.