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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1_3..- ....z ------- ------------------------------------------------- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued _. ._ _... 1 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. JOB ADDRESSA CATION--- __-------�._ jQ-- ---__ _ / Owner's Name_ - _ - --------- ----- Phone.................................... Address ..... --- ------\--------------------- Contractor's Name______ _ 4 ------- •-----------•------•---�- --------------------------------------------------------•---••-----.. Phone......... __'�L Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other E]Number of living units: ____�__ Number of bedrooms __ __ Number of baths _2__ Lot size _ Water Supply: Public system ❑ Community system ❑ Private�6epth to Water Table\5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe EF—Rardpan ❑ Previous Application Made: (If yes,date--------------------) .No New Construction: Yes 2--No ❑ FHA/VA: Yes ❑ No ®f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept Tank: Distance from nearest well_______________Distance from foundation____-__-___-__..__.Ma#erial___________________________.____________._____.. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---_-- Disp alFi ` L Distance from nearest weil__&V_1-------Distance from foundation____a`e--- ----- Distance to nearest lot line----`�'�_______ Number of lines----------/---------------- ___Length of each line--- _____ Widfih of trench_.__.__- -Y f � Type of fitter material _-Depth of filter material----fX --------Total length a g ... S Distancd to nearest ----_-----Distanc m fo ndation__�Ja_.___..__..Distance to nearest lot line...Number of pits.__--1--------------Lining material __, __.Size: Diameter__-33_ 47_ 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. Remodelingand/or repairing (desdribe) ------------------------------------ -------------•-----------------•-----------•----•--• -•-----------•----------•-•-----------•-------------•-- ---------------•-------•----------- ----- ------------------------ ----------------•--------------------------------------- ---------------- ----------------------------•------------------------------•--•---•-------------------------------•-----------•---•------------ ------ I hereby certify that I have repay d this app ication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul and egulations f the San Joaquin Local Health District. (Signed)--------------------- -------- ------ --- - - ------------------ - ----------------------------------------------------------------------.(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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.____ _-_____ _-_�4.-^- DATE__ --/------------ - REVIEWEDBY -----------��'-------------- ---------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------- ------=------------------------------------ •-------------- DATE Alterations nd/or recommendations:- _ � ----------.--------- �j --- / ---- -�---- -----' -- ------------------------ --------------------------...------------------- n ------------------------------------------------------------- -----------------------_------- FINAL INSPECTION BY:_._° _�-'-�Li �� � = Date 1 - ---------------------- r� - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EE-9 REVISED 9-59 F.P=C 2M 6.6D