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APPLICATION FOR SANITATION PERMIT Permit No. --_ �.___ ` (Complete in Duplicate) I _ r - "„� Date Issued .-- Aprj plication rs hereby made to the San'Joaquin Local Health District for.a permit to construct and install the work herein described. j This application is made in compliance with Countyy Ordinance No. 549. JOB ADDRESS AND LOCATION- _JJT _. _ �- ___ Qa t --------- -- ----- ------------------- Owner's Name-- --------- Phone ---------- Address. . . ----------------------------------------------------- Contractor's Name � �-- _ Phone •---- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ = - Number of living units: --/-- Number of bedrooms -Y-- Number of baths -/-- Lot size _--_- lre ------------------------- 6 Water Supply: Public system-❑ Com' mun'ity system E] Private Depth to Water Table ,� ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam [4o<lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: Yes ❑ No New Construction: Yes V '' o [❑ FHA%VA: Yes P '`No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) t� Septic Tank: Distance from nearest well-_ _ ____Distan�,;from foundation----,P------_-MatVial_-- _ __- 11� �'' f No. of compartments------�--_-___,__ Size- -- _-_---,-f.6---__--Liquid d ep .w,% /.__--____Cap cit - Disposal Field: Distance from nearest well.t�R_--____.Distance from foundation_,1p-------_--_Distance to nearest to °'. °- Len th of each line__-- .-y _- // Number of lines 9 / -- ----------- 'TypeWidth of trench- ---------------- of filter material-- lt ie Depth of filter mater;al--_� ---------__Total length--_-X;P7---------------•_,_______ Seepage Pit: Distance to nearest well-_ZeAO"'_ ___Distance from foun tion ------___.Dista to nearest loft line-`"'_,____.__._ Number of pits-_-------------=-----Lining material.. ze: Diameter.-s�---_. . Depth ------ ---- Cesspool: Distance from nearest well---------------t-Distance from foundation9---_-____-----.__--.Linin material---------------------- ❑. Size: Diameter------""---------- -------- ------ Depth-- -- Liquid Capacity s 7 : %r. . q p Y ----gals{-,. Privy: Distance from nearest well------------------------------- ------------_-Distance from nearest building ❑ Distance to nearest lot line------------------__-_�-Y•_------------------- - Remodeling and repairing (describe):---=------- -- �� t! -+ -----------•-----------------------------------•--------- - -1--- - ---------------------------------------------------------------------- •-------------•---------------------------------------------------------------------------------- ------------------------------------------••-------------------------------•-------•---••-------------------------------------------------------------------------------•-------•------------------- ------ ------- 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 re ulations of the San Joaquin Local Health District. (Signed)- --•------- Contractor) --------•------------- r 0 ' ---------------------------------------------------- Title { 1 -rte - ------------------ (Plot plan, showing size of lat,. ation o#'system in relation to wells, buildings, etc., can be placed on reverse side). 5 '' FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----:- X---------------- --_ --: DATE--------------- ---- -- =_== -------- REVIEWED BY--------------------- ------- '!F ------------ - DATE ---------------- ------------------------f- --�4 BUILDING PERMIT ISSUED----___P_=.___` _ ))�a DATE------ ------- Alt rations and/or recommendations.---------------- - ----•--------•------------•--------- tet, ---- -- -----------------------•--------------- ---------------------------•------- •-------. ------------ ---------- ------ -- ---- ----- - ------ r FINAL INSPECTION BY::- - ------------- ------ ate---- ------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American'Street 300 West Oak Street 132 Sycamore Street... 814.North "C" Street.-l' Stock+on, California Lodi, California Manteca, California Tracy, California` E5 -9-2M Revised 1-57 F.P.CO. ? s