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? APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete --.L(Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described: This application is made in compliance with County Ordinance No. 5 9. JOB ADDRESS D LOCATION_ . a�- ---- ---------- Owner's Name---- - ---------------- ------------ Phone---------------------- ------------- Address ------------ Address----------- u�m� --------- ---------------••------•----------------------------------••----------•---- �j Contractor's Name---- ---------------------------------------------- Installation --------------------•Installation will serve: ResidenceApartment House [ICommercial ❑ Trailer Court El Motel Other Number of living units: --I___- Number of bedrooms _.Z Number of baths ---I_ Lot size __ .x.-� �------------------------------ Wafer Supply: Public system 5Q Community system ❑ Private ❑ Depth to Water Table 4/-0__ ft. Character of soil to a depth of 3 feet:° Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑` Adobe Hardpan ❑ Previous Application Made: Yes ❑i No New Construction: Yes J No E] FHA/VA: Yes El No [-I 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-------x-------------Material------- --------------------------- _____________. ❑ No. of compartrnents--------------------------Size--------------------------------Liquid depth--------,--------------------Capacity----------------------- I Disposal Field: Distance..from nearest well_. a -Distance from foundation---I6__-.---------Distance to nearest lot line_---------- Number of lines----------------1____------------Length of each line--------------------------- Type - -----�`----------- _Width of trench------------'^LY._--y---------------- Type of filter material____�aq-----Depth of filter materia l____l$.�'----__._Total length t5______--------------I-_____ .9tE,le I t Seepage i Distance to nearest we _44�----Distance from foundation---Z3_Q.______.Distance to nearest lot line._S_____---- Nu'mber of pits.-1---.----1--------Lining material-___-- QC_�.Size: Diameter-___`yX_.0------Depth........ ----•--------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_------------ ---Lining material-------------..______---___________ ❑ Size: Diameter-t----------------------------------Depth--------------------- ------------------ ---------Liquid Capacity---------------------------•gals. I Distance from nearest building M Privy: Distance from nearest well------------------ --------------------------- 9 --------------- -- ❑ Distance to nearest lot line------------------------------------------------------------------------ ------ "" Ic �---- - Remod ling d/or re airin . (describe]:_-- i —---------------------------------------- - / ---- --------------- 1 -------------------------------------------- -- t ------ ,! - - ---------- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances. State ws, and rules and gul ions of he San Joaquin Local Health District. Si ned --------- (Signed) (Owner and/or Contractor) i ( 4 )------- --- --------- ------------------------------------------------- -------- Tale ---- ------ -- SY •-------------------- --------------------------------------------------------------{ P (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). . FOR DEPARTMENT USE ONLY ` f -- --G------- ---------------- APPLICATION ACCEPTED BY------------ •----- DATE` f ----------- DATE------------------------------------- -- ---------------- I REVIEWED BY----------- --------------------!�---------- ----U ---- -------------- ---- -------------------------------- BUILDINGPERMIT ISSUED---------- ------- ------------ - ------------------ ------------------------- ------------------ DATE------------------------------------------------------------- Alterations ------------- - DATE------------------------------------------------------------- Alterations and/or recommendatiaris:-----------_- -------------- --------------- -----------------------------•-------------------------------•--•---- -- -i - --------------- ---------------- ------------------------------------ ----------- ----------------- ------ ----------------------- _!_ -------------------------- ------------------------- ------------------------------------------------ ------------•-------------------------------------------------------------------------- ---- - ----------------------------- , ' -- ------------------ ..'-,-- ---------------------------------•--- -- -r- Jl------------------ FINAL INSPECTION BY .-_ : . Date-`-! - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North,'"C" Street Lodi, California Manteca, California Tracy, California • 5toek+on, California x ES-9-2M Revised B-'59 F.P.Co. x �.