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APPLICATION FOR SANITATION PERMIT Permit No. . (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 with County Ordinance No. 549. r �A•-`t` f JOB ADDRESS AND LOCATION .. --aZ ------- •-- ------f -- -- ------- ------------------•--------------------------------- ---3- ----------- Owner's Name-------- � 'a Phone Address----------------------------------....... - - --- �------ -- •- --------- __ Contractor's Name------------------------------•-•-•-•------------------------------------••-----------------------------------------------------------.------ Phone----------------------------------- Installation will serve: Residence W---A_partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [INumber of living units: _/____ Number of bedrooms -_Number of baths --- Lot size _ _._X__I_ _7'`_______________________ Water Supply: Public system ❑ Community sy�❑ Private Depth to Water Table �r-__ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loa r .lay Loam E] Clay E] Adobe❑ Hardpan ❑ Previous Application Made: Yes E] No W7New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r 0 1 Septic Tank: Distance from neatest well_S-6._ ____Distance fr m foundation_ 4Q--- - arial--------------------c--i-t- ------ city of compartments-.__ _�-�_-_-----Size._._ Liquid depth-,,.,. Capa � Distance from nearest welL' _Disposal Field: nle-1, line �- -----" 'stance to nearest lot line___- Number of lines_______. Length of each line-------+� d__ ---------------Width of --f ---- Type of filter material--_,�e- _ - _-Depth of filter material_-__.,�_?_--__.__.-Total length----__--14P_4-------------------- Seepage Pit: Distance to nearest well------------------__Distance from foundation-----------"!:_.Distance to nearest lot line----------------. ❑ Number of pits----------------------Lining material-----------------------Size- Diameter-----------------------Depth--------------------------------- t Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---____--__.---.---_.______-___--_---. ❑ Size: Diameter----------------------------- --------Depth--------------------------------------------r------Liquid Capacity----------------------------gal Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------.-_____.___.- ❑ Distance to nearest lot line.- --- -------------------------------------- ---------------------------=------------------------------------------------- ----------- N Remodelingand/or repairing (describe):--------------------------------- --------------------------------------:-----------------------•--------------------------}----•----•-•----------------- Q ---•-------------------------------------------------------------------------------------------- •------------------•----------------------------------------------------------------- ---------------------•------- M --------------------------.___-------_-._-___-__-__-----_--___-__-----_-_--____----______-------_-_---_----__-----___------.-._-_--_----_-_;_-----____-----__.___----_-__.--------___-----__-_---__-_---_----_---_____----__-_ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- 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)-------- ;_ _ _)/r,7104v"_00 ---------------------------------------- -------------------------------------------------------------------(Owner and/or Contractor) _. By:--------------------------------------••---------------------------------------------- --------------------------------:•-----------(Title)------------------------------- ------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R F MEN SE ONLY w' APPLICATION ACCEPTED BY------ --f- ATE____ _�V_ -- ----------- REVIEWEDBY-------•------------------------- --------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE--------------------------------------------------------- -- aAlterations and/or recommendations-------------------------- ---------------------------------------------------------------------------------------------------•-----------------------------. ---------------------------•----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------- ----------------------------------- --------.--------•------------------------------------------------ ------------------------------------------------- -------- ---------------------------------------------------- FINAL INSPECTION BY: - -------- -- Vv------------------- Date------... --------------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 Noah "C" Street Stockton, California Lodi. California Manteca, California Tracy, California ES-92M Revised 0,'59 F.P.Co.