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APPLICATION FOR SANITATION PERMIT Permit No. __.. ---_ _ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND TIO ,r -" . . Owner's Name f ----- ------------------------- ------------------------------------ ------- Phone------------------------------------ Address 1� (-5"---- --= f -- - Contractor's Name_______________ _ r ---------• - - - -- �--;-,• • ------------------------- -------------•----•----------------- ----. Phone Installation will serve: Residence M"-Aparfinent House.,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __r-- Number of bedrooms`._/__ Number of baths __4--_ Lot size ___tQ+ � --------------"-----_--___--_ Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table _ ,2i't. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe �ardpan C]Previous Application Made: Yes ❑ No New Construction: Yes 0<o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l i Septic Ta Distance from nearest well - Distances r nd t' /�--------.Material____ - --__ -- -- - --- ------ No. of compartments_ ' Q _ uid de th____. - -----Size - q P� -------- --- Capacity l t•; i. Disposal RId: Distance from nearest well... ___Distance from foundation___-/49- Distance to nearest lot Number of fines--------- _ Length of each line------ Width of trench_.A_ `"� ' Type of filter materia ./frl> _ --Depth of filter maferia___-- _ i !� g � ' /� ------Total length - =- Seepage t: Distance to nearest well-.--!-------- -------Distance from foundation_;! Q__-..his�c e to nearest lot Number of pits.---- Linin material Size; Diameter_ f ---Depth----.+> +""------------- 0 Cesspool: Distance from nearest well-----------------Distance from foundation---------"-------.Lin ing material--------------..__-.__._____._______ r❑ Capacity-.-.Size: Dlame#er---=------------ - -------------- Depth---------- -- ------------------------------,-,,-----Liquid-- ------------------------gals. Privy: Distance from nearest well---------------- _____________________Distance from ,nearest building.__________-----_-________-_-.___..____. Distance to nearest lot line-- ------------- 5: = s t 4 Remodeling and/or repairing (describe: - --- ----------------•------------- I ` " ----------------------------------------------------------------------------------------------------- -- -----------------------•----------------------•------ -------------------•----------------- -- —___.. ------------------------ ----------- ------ = = --------------------------------------=-------- ----------- I hereby certify that I have prepared this application4 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.' -' _ ___1�_1 - ._ -------- F _____ ------- �_____ 1 [SignedBy:--------------------- ----- -------------------------{Title) , Contractor) (Plot plan, showing size of lot, location of syst n relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-- _ Q_' . = DATEg------------- REVIEWEDBY _ ------------------------------------------- DATE------ "':r ' ``----__-------_------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------•----------------------- DATE- ----------------------------------------------------------- ' f Alterations and/or recommendations-------------------------------------- - ------------------------------••-----------------------------•------------------------•-- i -------------------------------"----"-----------------•-•---------------------------------------•----•------•-------------- •---•--------•---------------•••--------------- ----------------------•------------------------ { ------------•--------------------•----------- ---•- 1----.---- x __ _: _ - --- ------ �__�R�-�-------------------------- -15, FINAL INSPECTION BY: ---- Date --------- SAN.,JOAQUIN,,LOCAL HEALTH DISTRICT e 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Cc.