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APPLICATION FOR SANITATION PERMIT Permit f.Uw (Complete in Duplicate) Date Issued This Permit Expires 1Year 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. JOBADDRESS OCATION--- - AZ ------------- ------------------------------------------------------------------------------------------------•----- -••--------------------------- -------------------------------------------------------------- Phone----••---------------------•-------- Owner's Name - -- - ------------- ---- - Address---------------&-z --------------- -------------------------------•--------------------------------------------------------------------------------------------------------------------- Contractor's Name__. . `) " l s.i-------------------------------- ------------------------------------------------------------- Phone------------•------------....-.. Installation will serve: Residence [q'Apartment House ❑ Commercial ❑ Trailer Court ❑eo pl E] Other L]Number of living units: --_f__ Number of bedrooms .�.._ Number of baths ___/___ Lot size ________Ox ------------------------------- Water Supply: Public sysfem'❑ Community system Private ❑ Depth to Water Table .�U_ ft. Character of soil to a depth of 3 feet: ,San . Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous',Application Made: Yes E] No New Construction: Yes a—No ❑ FHA/VA: Yes ❑ No e— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------.----------Distance from foundation-------------------Material-.____________________________________________-. No. of compartments------------- ------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- D:sposal Field: Distance from nearest well------------------Distance from foundation----------___-------Distance to nearest lot line-___-_-_-__-__- Number of lines-----------------------------------Length of each line------------------------------Width of french___.____.-___,___.-_ - ------------ Type of filter material-------------------------Depth of filter material----------------------Total length_______-______________________________-_-- r r Seepage Pit: Distance to nearest well- ---------Distanc5 fo ndation___ r,S_....___.pistancHe to nearest lot line____-�_�________ C� [r� Number of pits---------/.__________Lining material__ __.-Size: Diameter_-__-_-3 -_.----- p pb 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 lot line----------------------------------------------------------------------- ----------------------------------------------------------------- ---- Remodeling and/or repairing '(descr-:6e):-------------------------------------------------------------------------- --------------------------------------- •----------------•---------------- ----------- -------------------------------------------------------•------------------------------------•---•-------------------------------------------------------------------------------------------------------------- ------------ -------------------------------------='-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ---------- ----------- ------------------------------------------------------------------------------------------------•------- -------------------------------------------------------------------------------- I horeby certify that 164 prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regula ' ns of the San Joaquin Local Health District. ------ -- -------------------- ---------------------------- -------------- ------------------------ Owner and/or Contractor (Signed)---- ---------------------------------- ------- 6 I ) b Blri---------------------------------- --- ---- -.--------------I----------------------------------------------------------(Title)---------------------------------- ...._.-------------------- I (Piot plain, showing size of lot, Iota Eon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------------- DATE---- ---------------------- REVIEWIEDBY-------------------------- -------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ---------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------•--•-------------------------------•-------------------------------------------------------- `I------------------------- -.----- ----------------------- --- --- ---•----------------------------- ----------------------------- W ---------------------------- , ' f.�� r -=------------------------------------------------------------- � - ---------- -----•------- ------------ --------------------------------=----------------- -------------------------------------------------------------------------------------------------------------- ---------- --- ------------- ----------------------- -------- --------- ---------------------------------------------------------------- ---------------- ---------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--- Date-----1 7 U---------------------------------------- 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 E5.9 2M Revised 8-'59 F,P,Co.