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APPLICATION FOR SANITATION PERMIT Permit No. ___1 a_t. 5 (Complete in Duplicate) 1 This Permit Expires 1 Year From Date Issued Date Issued ___ _ ✓�_ �O 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. , JOB ADDRESS A LOCATIONP- ----------- --- --- (� �ff Owner's Name =------------- --- ------:--------------------------------- - ------ Phone----�llf- _/7_f_� Address----------------------- = _ Contractor's Name_ - ar= -,►Q Phone-- f- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _____ Number of bedrooms _,6.,. Number of baths ---f Lot size ------PJ�tiG O Water Supply: Public system Community system C] Private F1Depth to Water Table ___.___- ft. Character of soil to a depth of 3 feet: Sand � Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: 'Yes ❑ No FHANA: 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-----------------Distance from foundation__________________Material_________________________________________________ ❑ No. of compartments------------- ------ -----Size------------------------•------Liquid dept----------- -----------.--Capacity-------------- Disposal Field: Distance from nearest well__--- Distance from foundation------1_6__ __.Distance to nearest lot line--.5-- Number of lines--------------I-------------------Length of each ��___-Width of trench__-��'�----------- Type of filter material__ _. _ L9 Q_Depth of filter material----- length---------_54__ _____________________ Q / - Seepage Pit; Distance to nearest well.__-_.''._______Distance from f ndation..... .....:.......Dist ce to nearest lot fe0`0__ __Number of pits--------I------_-----Lining material- ----Size: Diameter---.- ---------Depth-.._ - __-------_----- Cesspool: Distance from nearest we#[--------------___Distance from foundation--------------------Lining material----_-------------------._-_________- ❑ Size: Diameter------------------------ ---------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from-nearest well__------------------------------------------------ from nearest building--- -_-_--________________ . ❑ Distance to nearest lot 1ine--------------------------------------------- - ------------------------------------- ------------------------------------------------------ Remodeling and/or repairing (describe):--- ----- ----- Iry -p ------�`` ----------•-----•------------------------------------------•-----------------•------------------------------------------�----------•- -------------------•-----------•------------------------------ ------------------------------------------------------------------------------------•----------------------•---------------------------•---•--------------------------------------•-----••-•-------------------------------- -----------------------------------------------------------------------•----------------------------------------------------------------------------------------- ----------------------------------------------------------- i here fcertify�,fhgt,.I have-prepared this application and that the work will be done in accordance with San Joaquin County nce `-S ordinatale laws', and rules and regulations of the San Joaquin Local Health District. Si ned ERNIE'S SEPTIC TANK { g ) ------- -- Service L�adi - ----------- - or Contractor) -------------------------- Phone ENS-51101 trifle)-----/z --------------------=---------- -- �o,, �I �� ------------- [Plot plan, showin a of lo�, �beon of$ys�ei��in gelation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY DATE �'_ . ' ` �. REVIEWEDBY---- --------------------------------- -------------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED---------- ---------------I-------------------------------------------------------------------------- DATE------- ------------------------------------------..-------- Alterations and/or recommendations------------------ --------------- ----------------........------------`'---------------------•-------------------------•-•------------------------------- ---------------------------•---------------------------------•-------- ------------------------------------------------------------------ --------------------------------•--------------------------------•-------------- -------------------------------------------------••-.--------------------------------------------- -----------------------------------------------------•---------------•------------- --------••---------------- �k ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ i I !i FINAL INSPECTION LBY:. --- - --- ------ Date-_--------------- --------------------- - -- - --------------------- -------SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street - 814 North "C" Street i Stock+ort, California Lodi, California Manteca, California Tracy, California ES-9-21,4 Revised 8.'59 F.P.Co.