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APPLICATION FOR SANITATION PERMIT Permit No. .. ?.�.__5 � r (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 Ordinance No. 549. r �__ JOB ADDRESS AND LOCATION___ _____---------- ___ ------------------------------ ________________ Owner's Name-------1/,. ------ ---------------- Phon --ei '---7h Address-A-0.....�%-4----P__' .9------------------------------------------------------------------ ------•--------------------•-•--------.._---------------------- Contractor's Name, ------------------------------------------------------------------------ ---------------------------------- Phone---------------- -•------ Installation will serve: Residence PQ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:------- Number of bedrooms 4---- Number of baths 40-__ Lot size _______________________-_-___--__ Water Supply: Public system N1 Community system ❑ Private ❑ Depth to Water Table r!?- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No R New Construction: Yes N No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � _ ,,w� Septic Tank: Distance from nearest well---S-------Distan from foundation__l.C!--______.Material---l�'-�[✓Zt-u-------_______________ No. of compartments...2-______--------_____Size_�y -fr__IC___-___Liquid depth__. -------------------Capacity Ak" )NID Disposal Field: Distance from nearest well_._---------Distance from foundation---1-0-----------Distance to nearest o line--�-.__---__. Number of lines____________ ___ ______ Length of each line-_.._....V '____ ___--._.Width of trench.-_ _ Type of filter material Depth of filter material_____/_*-_!______Total length_____rrr_--.� - --- �e ----------••---- Seepage Pit: Distance to nearest wel---j/---_______Distance from foundation �____._.Distance to nearest t line- Number of pits____Z_____________Lining material_ ---------Size: Diameter____:`.-_.._._.___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-----------------------------------------------------------------------------------------------------------------.------ -------- Remodeling and/or repairing {descrihe):------------------------------------------•-------------•---------------------------------------•-------------------------------------------------------- ---- ---------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------•--- ----- ------- - ------------------------------------------------------------------------------------------------------------------------------------------------ - --- --- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules guiations of the San Joaquin Local Health District. - ------------- -------- Owner and/or Contractor (Signed)---------- ------------------------------ --- -------- { / ) By:----------------------------------------•-------------------------------------- --------------------------------------(Title)------------------- -------------------------- ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y__ DATE �"1 REVIEWEDBY------ --------------------- ---------- DATE--------------------------------- f BUILDINGPERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE------ ------------------------------------------------------ Alterations and/or recommendations:-------------- ------- -- ---------------------------------------------------------------------•----------------------------- ------------------------------- -I--- ---------------------------------- ----------------------------------------------- -----------------------------------------------•------------------------------------------------------------------------------------- -------------••---------------------------------------------•----------------------------------------•------------------------------•---------------------------------------------•-•--------------------------------------- FINAL INSPECTION 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, California Manteca, California Tracy, California ES-92M Revised a.'59 F.P.Co.