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APPLICATION FOR SANITATION PERMITZ Permit No. ..... .......... g� (Complete in Duplicated 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. JOB ADDRESS AND LO ATION---------3_'�--��------------ ----` ---�- - ---------- --------------------------------- Owner's --------------------- •-Owner s Name----------_ _____ ---4��-------- --------- Phone --------------------- Address -------------------- Address--------------------•--•-------------•------------•-•- - --- ----------------•----------------------------------------------- Contractor's Name - --------------------------- Phone Installation will serve: Residence Lg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J7 Number of bedrooms -1-- Number of baths Z---. Lot size ----------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table 2-2--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 3 Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes ❑ No g FHA/VA: Yes ❑ No (� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /Seis Tank: Distance from nearest weli________--______Distance from foundation__________________ Material_-_:_____-_.--___________-_-________..______-___- ��h s� No. of compartments_ Size Liquid depth Capacity Disposal Field: Distance from nearest well '-..._.Distance from foundation____!Z ---.---Distance to nearest lot line---- i ine___ Number of lines_______________ 01 ____----------Length of each line-_______3-----_"----.--.Width of trench________."7�__--"_"-"-- (,� __Total len th---------�-,----- Type of filter material-,X— �--___Depth of filter material-__/ ______" 9 T\ Seepage Pit: Distance to nearest well. '._____Distance from foundation___ __f?_°___.Distance to nearest lot line------'Z -.- Number of pits-_--------�---------Lining material---: az ---.Size: Diameter----j---------------Depth-------2-1----------------- 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��ine-------- ------------------------- ------------ ----------------------------- -•--------------------------------------•-------------- i Remodeling and/or repairing (describe):__ "- ------ •- / �Zz �-Y' 1� � '-------------yyy�� / ---- ------- � )---------- = ----- -- ------ _._ r -------- --------------------------------------------------- --- --- ---- ---------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, a d rules a ' regulations of the San Joaquin Local Health District. ___----.(Owner and/or Contractor) Title---- - ---------- - ---------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------ ---- ---- ---- ----------------------------------------------- DATE------------------ — ---- ----- REVIEWEDBY----------------------- ----------------------------------------------- ------------------------------------------------------ DATE---------------- ------------------------------------------- BUILDING PERMIT ISSUED DATE------------------------------------------------------------- Alterations an /or recommendations:-------------- ------- ---------- ------------ ---•---------------------------•---------•-------•------------.- - ------------- - ------------------ "J e�� ----�_ _ -- / -" -- ------ -------------- - ----- --- ------ -- ��----�-------------- ------------ - - ---- ,� ��.« �� ._ - ------------ --- ----- -------------------- -------- - G 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 + i Tracy, California F ES-9-2M Revised 8-'59 F.P.Co.