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� , � APPLICATION FOR SANITATION PERMIT Permit No. ....�f ��.. ® (Complete in Duplicate) Date Issued _671-S-16_o 1,O 33 Z S _��C Es7— , Tfiis Permit Expires 1 Year From Date Issued �C�3 t Zip --��"---- " 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 madeinn compliance with County Ordinance No 49, JOB ADDRESS AND OCATION-- Owners Name_____________ one Address f .. Contractor's Name__________________ __ :_-__ Phone - -- --- --------------------------------------------------------------------- Installation will serve: Residence [B—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/ Number of bedrooms __,Number of baths _l.--_ Lot size __- � ________________-__ Water Supply: Public system E] Community system F1 Private 2r--Depth to Water Table/15ft. Character of soil to a depth of 3 feet: Sand [3—G-ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Eg—New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Ta k: Distance from nearest well�_. .. Distance from foundation__312_ .__-_-Material-__e��._ -" N [ No. of compartments____-E-,:A----____-_-.__Size._�_3.- 3_4a____-___Liquid depth___ —---------Capacity__ _ Disposal Feld: Distance from nearest well._6'D__ (13 �" Distance from foundation__�(O_._.....Distance to nearest lot line_____��__ T [r Number of lines--------__ - ______ __Length of each line_I[4�_I------Z/Q_�._.Width of french_..__.��_y-------------- V Type of filter material-__&� Depth of filter material__,$"_____._____Total length------ a__--_____________._____ 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_________________Distance from foundation--------------------Lining material ----------------------------------__. El Size: Diameter--------------------------------------Depth------------------------------------- --------------Liquid Capacity gals. vko Privy: Distance from nearest well____---------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------ _------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- - •- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ---------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- - i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate a s, and rules and regulations of the San Joaquin Local Health District. {Signed} ------------- ------------------- Owner and/or Contractor) , By:---------------------_-- -----------------------------------------(rile) --------------------- - . (Plot plan, showing size ofot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------- --------------------------.............. DATE--•-- - - - --------- - --------------------------- REVIEWED BY - ---- -- - ------------------------- DATE------- ------ BUILDING ---• BUILDING PERMIT ISSUED------------------------------- ------------ DATE------- _------______-- - Alterations and/or recommendations:----------------- ---- -----------------------------------------------------------------------•------"-------"------------------------------------------------ -•---•---------------------------------------------------•-----•---------------- ------------------------------------------------------•---------------------•---------------------------------------•---•------------------- -------------------------------------------------- ------------------------------------------------------------------------- FINAL INSPECT -- ---- --- Date `s �'r%Q------- --- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Co.