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APPLICATION FOR SANITATION PERMIT Permit No. .__ll...__ (Complete in Duplicate) pate Issued _ This Permit Ex ires 1 Year From Date Issued � Application is hereby made to the San Joaquin Local Health District for a permit to constructPlIkill" stall t e wore erem described. This application is maderin.complioncV,-T h County Ordinance No. 549. �� t IP!Z lS� JOB ADDRESS AN D LOCATION_V -t- '------- ��----- - ��I>� -.- �-��------------------- -------------------- Owner's Name------ Address --------------- ----- - ----------- Phone.__.T Address--------------- ---------...-----------------•----------------------------- ----------•-----------------------------------------•--------- Contractor`s Name-------o-Gl9_f,IR- -------------- -------------• ------------------•---- Phone----------------------------------- Installation will serve: Residence U3%,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1. Number of living units: __�---_ Number of bedrooms __�1 Number of baths ---I---- Lot size _--_#�_-_ --------- ------------ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table ---6 ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EL Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ i Previous Application Made: Yes E] No g, New Construction: Yes Rk_ No E] FHA/VA: Yes F] Nom p TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.{ ' Septic Tank: Distance from nearest well___%1 ------Distanceffroounr�ation----. �y �G M te�ial---- � � i No. of compartments.... ------_-- Size.�� _y._1!__�17.------Liquid death_.. . ------ Capacity----C_f. -- - r � Disposal Field: Distance from nearest well-.-ZZ f.-Distance from foundatio __.__0---------Distance to nearest lot fine-Z---___- r� Number of lines--------- __ ___---Length of each line----__ Width of trench..-.. .__- i De th of filter material_- i Ti------------Total length -—------------------ (� Type of filter material----- .-- - p Seepage Pit: Disfance to nearest well----------------_----Distance from foundation------------_----- to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------- -----------.Depth---------.---------------------- Cesspool: Distance from nearest well--------- -------Distance from foundation--------------------Lining material---------------------------____---- ❑ Size: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. 1 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ,� a ❑ Distance to nearest lot line- - --------------------- ----------------•------------------------------------------------------------------ Remodeling and/or repairing (describe):------------------ ------------------------•-----------------------------------------------•-----t- -----------------•-----------------------------•-• ------- -- ---- i --------------- - - - ---- -------� `� 4-----1- �Cz:------- ------------------------------- �ki _ -= I hereby eertify that I have prepared this application 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. IJ"-- -- - ----------------------------- ----------- ----------------------------------- _ , (Owner and/or Contractor) (Signed)-- I ------- -------- -- - ------------------Title---------- ----------------- - ------------- - -- -- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY------------------- - r- DATE--------- --`1.- - -- ------------------------------ REVIEWEDBY------------------------------------- ------------- ------------------------------------- DATE--- --- ------------- -- BUILDINGPERMIT ISSUED--------------------- - ------------------------------=------- DATE----------------------------------------------- -------------- Alterations nd or commendations: ---------- ---------------------------------- --------- ------- - -------------- _ -------------- - T a _ - ...— J - ------ ------------------- -'- .�� _�1� � .---- -- - -- ------ -------- - s - .� -------/.r-cs FINAL INSPECTION BY--------------_- Date----------------- --- --Z � v --- ------- -------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California F is;9-2M Revised 8.'59 F.P.Co.