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APPLICATION FOR SANITATION PERMIT Permit No. ... ✓� _ _.. (Complete in Duplicate) .. pate 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 Ordina ce No. 549. JOB ADDRESS ANQ. 00ATI N _'.__� _�� -- --'� �-- --�."�-------------- - Owner's Name)--- ------ -------- --- ------------------------------------------------------------------------ Phone Address----------�----�_ �------------------------- --------------- --------------------------------------------------------•-----------------------------------------------...----- Contractor's Name------ ------------------------------ ------------------------------------- --------------------- InstallationPhone ° will serve: Residence/I Apartment'House ❑ Commercial ❑ Trailer Court E] Motel E] Other E]Number of livingunits: _-_E___ Number of bedrooms _Number of baths __�•_. Lot size __ r -.�-._ __ .�------ Water Supply: Public'system E] Community system ❑ Private `Depth`to Water Table ft. °' 3 Character of soil to a depth of 3 feet: Sand k, Gravel Sandy Loam El Clay Loam E] Clay ❑ Adobe❑ Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ElNoJ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or'cesspool permitted if public,sewer is available wi+hin 200 feet.) pp Ma erial ----------- Septi Tank: Distance from nearest well- if----- _Distance from foundation_____,____ __ No. of compartment,----,512 Liquid de th_____ .� Capacity----- Disposal a acit p G p. `--- p y--= it Disposal Field: Distance from nearest well--__ _ 0.____-Distance from foundation____`__.____..._.Distance to nearest lot line-- Number ine�_-Number of lines________--.__._ - Length of each line-. �_'�+��.Width of french-_-__---�X- ®. ��°° EDe th of filter material___/-R-1(i Total length__-..__1/_0Q______________________ ' Type of filter material-____ _(.__� p - Seepage Pit: Distance to nearest well-----------------------Distance from foundation___ ______.._-__..Distance to nearest lot line----------------- t''1 ❑ Number of pits-------.-=------------Lining material-----------------------SITE: Diameter`- -• -----------------.Depth.. -- --- ---------------------- `" Cesspool: Distance from nearest well-----------------Distance from foundation____________________Lining mater-sal__-______________---________________- ❑ Size: Diameter--------------------------------------Depth------- Liquid Capacity ----------------------gals. Privy: Distance from nearest well--:.'-..------------------------------------------Distance from'nearest building_;__.____.______-.-_---___.________-_-.-. ❑ Distance to nearest lot line---___---------------------s. --------------------------'-"""` .. " Remodeling and/or repairing (describe):-____..�� ____��_'�"'�_��.�.--- "-� '��----�-- �_'_'?--�_-�-ti�-�--• ----------•------------------------------------------------------------------------------- #f -------------•---------••-------------------=------------------•---------------------------=--==-----------------------------------=--------------------- - -----=--------•------------•-------------=--------------------------•-------•----------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. c� T'". '4°-n---r-`---------------------=--------- - ----------)Owner and/or Contractor) i (Signed) ' ------------------ - --k - -•------------------------------------------------------------.. 5Title Plot plan. showing size of lot, location of.s sfem in relation to wells, buildings.- etc. ( ) _-- _-- s _-- Y- � P 9 y , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------ ---------------- ---------------------------------- DATE-------------------------------------- ----• -------------- REVIEWEDBY------------------------------------ ------------ ----------- -- ----- --.-?---------�.----•------------------------ DATE------ l BUILDING PERMIT ISSUED --------------- C-f --" DATE le Alterationsand/or recommendations---------------- ---------------•-------------- --------------------- ---------------------------•---------•---•-•------•----------------------••------------- -------••--------------•----------------------------------.------- --- -------- ----------------- ------------------------------- ----------------------------- -------------------------- - ---- - --- -- ----- -- --�------ ---------------------------------------------- ----------------------------------- ----------------------------- FINALINSPECTION 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, C lifornia Manteca, California Tracy, California ES--4-2M Revised 1-57 F_P.CO.