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- APPLICATION FOR SANITATION PERMIT Permit No. _.�. ,• •� {Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued pate issued .��_© Application is hereby made to the San Joaquin Local Health District for a permit to construct and insP II the work herein described. This application,is made in compliant unty Ordinance No. 549. JOB ADDRESS ANDL ATION1.- � a r 1 � `' 9C Owner's Name-----------`-`�!�_--•- -- -- ------------- ---•-----•- --- -- _/� ------ ------------------------ Phone.--- - ------- Address -- =•- --------------------------- Contractor's Name ------------------- -- Installation will serve: Residence ❑ A artment'House ❑ Commercial f Trailer Court ,z L] Mot ❑ Other ❑ Number lof living units: _______ Number of bedrooms __,_____ Number of'baths -------- Lot size ------ Water Supply: Public syste ____ - -------------------•----•-- m^❑ Community system ❑ Private Previous Application Made: Yes ❑ Depth to Water_Tabk l T: ft:--- Character of soil to a~depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ClayL -. oam ❑ Clay ❑ Adobe[I Hardpan ❑ No d9( New Constructioii: YesK No ElFHA/VA: Yes ❑ Nq:541 TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool''permi fed if public sewer is available w hin 200 feet.)f I�._- � i /?� Tank: � Distance from nearest~'welL_�O------Distance from foundation____��_�__.__.Mat ria)______________u '-�17 f�-------------- -----------.. No. of compartments-1,--_ ,_-- Size=aX_ cL_------Liquid depth------g-_- -----Ca acit _ ._ e ttc P -__8 �, P Y ----- Di spo al Field: Distance from nearest"wel!__ - p+stance from foundation___1 Distance to nearest lot line Number of lines----- � 4 / d1� � Length of each line_ _-- Width of trench.___Q Type of filter material_ -- ^ Depth of {filter material______) ;______Total length____ ----- F Seepage Pit: Distance to nearest well_ ____________Distance from foundation_____•_-___-$.------Distance to nearest lot line_._____._______-- •J ❑ Number of pits-------------------- Lining material----------------------.Size:sDiameter---------- ---depth` ----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation _Lining material-------------------------------------- r ❑ Size: D,ameter --------Depth--------------------------------=------ -----------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---- ---------------k----------------------------Distance from nearest building________.________________ ------------- ❑ i Distance to nearest lot lin Remodeling an or repairing (describe):__ -_ --------- _ ( � ----- - .----- ---- ----------------- ------------ ------ --- ',�^ I�. -------------- --------------------------------------------------- -------------------------=----------------------- ------=----------------------- - -- ---- - - here certify that Ihave - -' -- - � ---�-- ------------------ I Y Y prepared this application land that the ork will be done in accordance with San Joaquin County ordinances, State I an ales an egulations of the San Joaquin Local Health District. (Signed).,�__ - --- _►__ ---------- - ---------------------------------------------------------------------------------------------(Owner and/or Contractor) By:----------------------- 9 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 BY-------•-------------- ----- - DATE_-__-. - _- ----------- -------•-------------- - ----------------------------------------- DATE------- �l D• BUILDING PERMIT ISSUED- - DATE---------- Alterations and/or recommendations:______..__.________________ _ - .---------------------•------------------ --------------------------------------------------------------------------•------ = _ -------------- ---------------------- --- - ------------------------ ---- -- g 6r FINAL INSPECTION BY:..... .... .._tl/ --------------- ....... -----l 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-9-2M Revised 8-'59 F.P.CO.