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APPLICATION FOR SANITATION PERMIT Permit No. .4.2..a .� {Complete in Duplicate} Date Issued ___ .c 1 This Permit Expires 1 Year From Date Issued ..- Application is hereby made to the San Joaquin Local Health District fr a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N . 5 9. JOB ADDRESS AND TION -------lf Owner's Nam -•--cs -- ------•---------- -- -- • -- --- --- Phone------------------------------------ Addres w . -------- ---- --------------------------------------------------------- Contractor's Name =t ---------------------- Phone----------------------------------- Installation will serve: Residence partment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- Number of bedrooms Number of baths /. Lot size _--� -. .---------------------------._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table%_ t. Character of soil to a depth of 3 feet: Sane[ ❑,Gravel ❑ Sandy Loam ❑ Clay Lo m ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes .E] 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.) �ti T Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------____------. No. of compartments----------------' ---Size-------------------------------.Liquid def? h--------------------- ---Capacity----------------------- d ------- -------------d: Distance from nearest w II_ Distance from foundation---_- ?7------ to nearest of line S py �t-------------• N Number of lines---_ -__-_ -- Length of each line----4ZO-_j_ _____ _____Width of trench---_ Type of filter ma 4, _-_Depth of filter material----.f--- -___Total length---------------------- -----------._ 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_-..-__---_.--.----------------------. + ❑ Size: Diameter----- -------------------------------De th---------------------------------------------------Liquid Capacity----------------------------gals. 9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------ _---_-_--. ❑ Distance to nearest lot line Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------•-----------------------------------------------•----------------------------------------- ----------------------------------------------------- ------------------------------------------------------•---------------------------------•--------------------------------•------------------------------------------------------------------------------------------- ----- ------------------------------------ ------------ --------------------•-----------------------•---------------'----------------------------••-------------- --------------------------------- ----------------- ------------- I hereby c i y hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate law , and rules nd reg ons of the an Joaquin Local Health District. (Signed} - •----•--------- - - ----- - �- - - --- --1----- - --------------- --- -------------------.-- -- - ner and/or Contractor] Plot plan, showing size of lot, location of system in relation - --------- - (Title)-_-- I By------------------------------------------ -- -- - - ( p g y to ells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------�-TR`?-------- ---------------------------------------------•----------- DATE--------- REVIEWEDBY-- -------------------------------------------------------------- ---------- ----------------------------------------------- DATE---------------------------------------- BUILDING --•---•-------------------•---BUILDING PERMIT ISSUED------------------------------------- -----------------------------------------------------------•---- DATE Alterationsand/or recommend ations-------------------------- -------- -----------------------------------------------------------•------•----------------------------------------------------- f ----- --7---`----------------- I+. ---•------------------------------------------•--- -- - ..----------- ------- --- ----- ---------------------------------------------------------------------------------------------------------------------------- -- - --- - ---------------- ----- --- ------------------------------ FINAL_ iNSPEC 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.