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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 5 JOB ADDRESS AND TION.----- -------- me Phone------------------------------------ --—------------------------ -------------------------------- Owner's Name----------- ----- ---------------- ------------------------------------------------------------------------------------------ - ------ -------------------- --------------------------- Address------------------- "�'49 Z-4 ----------------- Phone------------------Contractor s Name----- - - --------- Installation will serve: Residence Apartment House El, Commercial E] Trailer Court [I Motel 2��Cither El Number of living units: -P--El Apartment Number of bedrooms Number of baths --A- Lot size __4___ , ------------------------------ Water Supply: Public system El Community system 0 Private Z31�Depth to Water Table AjW-'ff. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam E] Clay Loam [] Clay 0 Adobe Hardpan [3 Previous Application Made: Yes El No � New Construction: Yes E] No P?- FHA/VA- Yes 0 No Kj— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well_________________Distance from foundation_--___________.__Material----__________._____--.__________-____________- No. of compartments------------------- -----Size--------------------------- ---Liquid depth---------------------- ---Capacity---------------------- Dis sal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line-----_------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------•----------------- Seepage Pit: Distance to nearest Distance from foljgdation--%�Fsr--/-..Disfance to nearest lo line--4&V------- . I P- --------------- /"----Depth---- Size: Diameter.--- Number of pifs- - -/--------------Lining material/ -;�- ----- from foundation______.____________ Lining material------------------------------------- Cesspool: Distance from nearest well Distance ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building_________.___-_-__________________---.._. ❑ Distance uilding------------------------------------------ Distanceto nearest lot line- --------------------------- ----- -------------I------------------------------------------------------- ---------- Remodeling and/or repairing (describe):-------------- -------I-------------------------------------------------------- - - - ------- -----------6� --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ------ --- --------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- -----------------------------------------------------------------I--------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul%S and regulation Of the San Joaquin Local Health District. C- (Signed)------------------------- -------0- --------------(GNmer-mv#0 Contractor) By:------------------------ ------------------------- - ------- ------------------------- --v- -- -------------- (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can 64'placed on reverd'side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --------- ---------------------- DATE ------------- -------------------- REVIEWED BY------------- --------------- - -------------------------------- ----%/%------------------------------------------------------------------------------------------------------------------------------ -------- - DATEM - -- BUILDING PERMIT ISSU'ED------------------------------------------------------------------------------------- DATE 0Q, .Alterations and/or recommendations:-------------- ------ -------- ---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- -------------------------------------------------------------I----------------------------------------------------------------------------- --------------------------------------------------- --------------------------------- ----------------------------------- -------------------------------------------------------------------- - ----------------------------- ---------------------------------------------I---------------------------------- ------ FINAL INSPECTION BY------ Date 71!! ----------------------- -------------- --------------------------- -------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street M Stockton, California Lodi, California anteca, California Tracy, California -ES-9-2M 3 Revised 1-57 F.P.CO.