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a APPLICATION FOR SANITATION PERMIT Permit No ....:. _:0 (Complete in Duplicate) 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 th County Ordinance No. 549. b ° ` �1 �, = -------- --- --•------- --- JOB ADDRESS AN LOCATION___________ _____ __ OF Owner's Name_ --------------------•------------------- --------- ------ -- -. Phone------------------------------------ Address Address ` ------••----- --- --- - --•-------- - Contractor's Name- �- ---'--------••----------------••------•---------------------------•--------------•---------------•-------------------- Phone_.-.----•--------•----------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial 06 Trailer Court ❑ Motel ❑ Other ❑ I �,/ � . Number of living units: -------- Number of bedrooms -------- Number of baths ---l-_- Lot size __,_f x__11-r _� ----------------------.-.---_ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table tCR ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Dt Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N ! Septic Tank: Distance from nearest well----------------- from foundation--------------------Material________________________________________________ ❑ No. of compart'encs--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disxal Field: Distance from nearest well--- -® Distance from foundation----LO---------Distance to nearest lot line__________.__ Number of lines`_____ ____ Length of each line___-- - 3 9 �-� - --------------Width of trench--- �0---.-------- ---------I Type of filter materiallDepth of filter material-__� _��---------Total length___ '!Seepage Pit: Distance to nearest well______________________Distance from foundation___--__________-__-.Distance to nearest lot line__-__.--__-_.-❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth------------------------------Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------- ___.___________ ❑ Size: Diameter- 4----------------------------------Depth---------------------------------------------------Li Liquid Capacity q p tY --------------------------gals. t Privy: Distance from nearest well-_-_____________________________---------------Distance from nearest building-___.-.__-_--__--_____________--__-.__ ❑ Distance to neariest lot line--------._.-------------------_ Remodelin and/or repair' desc libe :____-_- _ __y_ -------ti�have ---•-- --- -- ---/ I hereby certify th prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulafiang of the San Joaquin Local Health District. (Signed)_.---- - -- --- ------------- � ------------------------------------------------------------------------------------------(Owner and/or Contractor By: ------------------------------------------t-------------------------------------------------------------------------------- -----(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_- REVIEWEDBY ------------------------------------------------------ DATE----------- •-------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------- -- - -•--------------------------------------- DATE Alterations and/or recommendations----------------------------------------------- •------------------•------------------------------•---------•-----------------•------------ --------------------------------------------------------------------------•------- -------------------------------------------------- ------=----------------------------------------------------------------•---- I --- ----------------------------------------------- ----------------------------------------------------------------------•------------------------------••-----••------------------- --------------------- •--- 1 -------------------------------------------- i ----------------------------------- � p. 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 Tracy, California ES-9-2M Revised 8-'59 FTP Co.