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APPLICATION FOR SANITATION PERMIT Permit No...1.?.__ {Complete in Duplicate) This Permit Expires ] Year From Date Issued Date issued ____%�� Q 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 o. 549. JOB ADDRESS AND LOC TI N_..._+_• 3'`�^,-= �,•. )---------------------------------- Owner's Name��' (---------------- -- Phone ------------------------------------ Address........................ ------------ Contractor's ---------- Contractor's Name -------------------------------- ---------•--------------------------------------------------------------------------•----•--------------- Phone ----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ " otel ElOther ❑ Number of living units: J__ Number of bedrooms 3--. Number of baths __l--- Lot size -______ %___________________________________ Water Supply: pp y: Publicsystem ❑ Community syste. ❑ Private W-15epth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam E] Clay Loam ❑ Clay E]Adobe C]Hardpan E]Previous Application Made: Yes ❑ No ['_New Construction: Yes 0-11-0—El 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 nearestwell_ tan e�Tr m founjxtion_A_ vlaterial_ ------------------------------- No. --_-------No. of compartments ............ 2.. --------- sSize_ -�[-_, -- _____Liquid dei? h,___-�_f---___._____Capacity ___ 4-.D {� J e ,►1 , Disposal Field: Distance from nears ell -5-! ance from foundatio ___>A_"?'+'4"'$istance to nearest lot line__.--- *� Number of lines_-____ -__-Length of each line.... ___.Width of trench Type f� -- M 9 - --- Type of filter material__5r__ _ __.__ ____ epth of filter material______ ______- Total lengfh_____�' Seepage Pit: Distance to nearest well ---------------------- Distance from foundation -------------------- Distance to nearest lot line --------------- .. ❑ Number of pits --------------------- Lining material ---------------------- -Size: Diameter ---------- k------------ Depth --------------------------------- Cesspool: Distance from nearest well -------------- --_ Distance from foundation ---------------- _--- Lining material ____._---__.-_..____.________________ ❑ Size: Diameter-------------------------- ----------- Depth --------------------------------- ------------------Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building- ----------------------------- -----------. ❑ Distance to nearest lot line ---------------------- --------------- r ir- Remodeiing and/o rewiring describe):-- -------------------- ........ ��_.. ..�� �. .z - �,, '----------------- - ----------- -----------------------------------------------------------------------------------------------------------------------:----------------------------------------------------------------- -- -------- 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. t Si ned { it --- - I 9 } ---------------------------------------s•-------------------------------(Owner and/or Contractor) By:._ ---- ''�-•�---- _�", - --..' + --------------------------------------------------- (Title) ------------------------------ --------- --- - ----------- - (Plot plan, showing size of lot, location of system in dation to wells, buildings, etc., can be placed on reverse side). FOR D.EPAR)1 ENT JI SE ONLY f APPLICATION ACCEPTED BY�� f ._Q----------------------- REVIEWEDBY ------------------------------------------------------------------------------------------------------------------------------ DATE - BUILDING PERMIT ISSUED ----------------------------------------------- ------------------------------------------------------ DATE Alterations and/or recommendations:----------------------------------------------------•---••----•---------------k--------------•-------------------------------. FINAL INSPECTION BY: --------41< ----------------_-----------_ Date------ — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reet 300 Wes+ Oak S+reot 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2AA Revised 8-'59 F.P.Co.