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APPLICATION FOR SANITATION PERMIT Permit No. ..............-->-. (Complete in Duplicate) 1/3& Date Issued ----------- -1- This Permit Expires 1 Year From Date Issued v c5-_ (qo_( - Application is hereby made to the San Joaquin Local Health District for a permit to co ork herein described. This application is made in compliance with County Ordinance No. 549. ED � ZJOB A�D RES NDD L009N ---- -- "" /-ilks ` .. . ---------------------•-••------------------------ --------------------------------------- Owner's Name_ ______________ �_._ _ _ Phone___.___ Address:.. '"�' a R....... -- Contractor's Name------- F f * --------------------- Phone-- - Q. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units:,U_ Number of bedrooms -------- Number of baths _*. Lot size ._____._-_-_-5---0-_ ewrA_ -------•--••-----•- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 4.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-4 Adobe [:] Hardpan ❑ . Previous Application Made: Yes d No PY New Construction: Yes El No W FHA/VA: Yes ❑1 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic t Tank: Disfance'from nearest well-----------------Distance from foundation-------------------.Material----------------------._-____________._-_-_-_-_-. ❑ No. of compartments--------------------------Size--•----•------------------------Liquid depth----------------- Capacity ____.___ ----------------------r Disposal 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------------------------------------- rr See a e Pit: Distance to nearest well------/_d-d_ _Distance from fo ndation__.� Distance to nearest lot line----- Number of pits--------I------------Lining material__�l -Size: Diameter-------a_3._.....Depth------2-,S*_____________ Cesspool: 'Distance from nearest well-----------------Distance from foundation--------------------Lining material______________________.____________ [l Size: Diameter--------------------------------------Depth--------------------------------------------------.-Liquid Capacity-- ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___._____._____________________.._. ❑ Distance to nearest lot line------------------------------------------- ----------------------------•----------------------------------------- --- ------------- c Remodeling a e)' 'r' ----••---- \n ---------------------------•----------------------------------------------------------------------------------------------------------------------•------------------------------------V------------------------------------- ll ----------------------------------------------------------=--------------------------------•--•------------------------------------------•-----------------------------------------------•--•------------- �Q -----------------------------------------------------••----------------------•----------------------------------------------------------------------------------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed)-------_4'/ ------ °r Contractor) B ---------t-E1E_^�2�d -----Lot----- ---- --- ----- Title--------- - (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY- ------ - ---------------------------------------- DATE----`'l,2- -------------- G-------------------- REVIEWED BY------------------------------------------------------------------- --------------------------------------------------------- DATE-------------------- --------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- ---------------------------- ---------------- -------- Alterations and/or recommendations------- ---------- - --------------------------------------••---------------------------------•----------------•--•-------------------- --------------------- ------------------------------------------------------------------------------------------------- ---------------_--------------------------------------------------------------•---------•-------------------------------- -------------------------------------------•----------•------------•-------------------------------•---•----------------------------------------------•----------------------------------------- ----------•-•--•-- ------ ---------------------------------------------------•-----------------------------------------------------------------r-- '=----------------------------------------•------------------------------------------------------- } 1,;2- -,? o - 6d FINAL INSPECTION BY: ----•-- ------------ Date-- ----------------------- -- ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 6-'59 F.P.Co.