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APPLICATION FOR SANITATION PERMIT Permit No. (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 Ordinan e No. 549. JOB ADDRESS AND L ATI --------- ------- -- --------------lcd --- --- Owner's Name---------1�" � -------------------------------------- -------------------------------------- Phone.---••---------------------------_-- Address-----------------C910. �1./------ - -- - ---------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------------ •-•-----------------•----- Phone---------_-------------------•-- Installation will serve: Residence W3---Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: /___ Number of bedrooms -%,I- Number of baths Lot size __ __A& ___'___--_____________________ Water Supply: Public system ❑ Community system W<vate ❑ Depth 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 E❑ No New Construction: Yes Zjo-Mo ❑ FHA/VA: Yes 94—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or cesspool permitted if public sewer is available within 200 feet.)) Septic Tank: Distance from nearest well_ -----Distance_ from foundation__Af 7-.___Material___Cl_�.- _ -- --------------- No. of compartments----- ________Size��-,Ve0,?Ak _Liquid depth_______..-..-.-_-____-.Capacity_,) �Q---- Disposal Field: Distance from nearest well-------'--__Distance from foundation----W_.------------Distance to nearest lot line------------ Number __------_ -Number of lines-------- ------------- ------Length of each line_ / r0---- _--Width of trench._ ___ _'�� .------------------••- Type of filter material_- � epth of filter material...le//�f...Total length___� __�______________ __ Seepage Pit: Distance to nearest well_______"'_____Distance fr foundation---Zii'"___.___.D'st ��e to nearest lot line__�� �(sf -Size: Diameter-,_X_;/ -_.._ p Number of pits__.___ y�__._..______Lining material___ ___ _ _--De th___��i�r� - 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------------------------------------------- --------------------•----------------------------------------------------------------------- Remodeling and/or repairing (describe):----------- __ ------------•----------•------------------------- `�__.-�- -------- °'� ------------------- --------------------------------••----------------------- --------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this a'ppiication 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)----------- - -�-�"��"- - - --------------- -------- ------------------------------------------- -(e-..........ll.�er Contractor) By:--------------------------------------------------------------•-�-- ----- ------ �r ------------------(Title)----- '��v�--'-------- -------- (Plot plan, showing size of lot, location of system in anon to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATIONACCEPTED BY----- ` = '---------- ----------------- ---------------------------------------- DATE------ ------------------- REVIEWEDBY-------------------------------- ----- ---------------------------=------------------------------------ -------- DATE-_---,-..;-------------------------------------------------- BUILDING ATE-_---, ..;-------------------------------------------------- BUILDINGPERMIT ISSUED----------------•------------------------------------------------------------------------------------- DAT E------------------------------------------------------------- Alterations and/or recommendations:-._-__.___ f __ 5-----------��------ ' - /.7------ ----------------- --------------------- ---------------------------------------------'------------------------------------_-- _-- -- -- -----------------= ----- - --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ - FINAL INSP TION BY-- Date-----/ ---~- .7 7------------------------ 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 6-'59 FYCo.