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APPLICATION FOR SANITATION PERMIT Permit No. .... � ' (Complete in Duplicate) This Permit Ex ires 1 Year From Date Issued Date Issued .--..---- - p d 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 LOCATION------- _ ---------------------------------=--•---••--------------------------------------- Owner's Name- l1 - -�+ l ----------------------------------- Phone ------------ Address " ------------------------------------••---------------------------------------------•-••-------------------•---------------------------•-----•--•----- Contractor's Name--------------- ----------------------------------------------------- Phone.®''-e Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms --Number of baths -` Lot size -_-_- Water SuPPIY� Publics stem ET"'Community system Private Depth to Water Tablesr _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay [] Adobe Hardpan C)Previous Application Made: Yes E] No 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.) , Septic Taanl<.. Distance from nearest well-_;2t#?1Zistanc from fo ndatipn_-,_&f--------Materia No of compartments Size �f�-- P �------ - ----�° - -X-----Liquid depth---- � ---�-----Capac3tY---- �-- ---�/ D,isposa Fie#d: Distance from nearest well.-.�%l Distance from foundation--.l_d.,------.Distance to nearest lot line`---`�-----..... ( �'I,estt� Number of fines----------- --- -------_----- --Length of each line---------- -�. � _ Width of trench___-�- -_•j-------------•-- Type of filter material �pth of filter material____.�_c _-_ ------Total length___--- �---------------------- Seepage Pit: Distance to nearest: Distance from foundation-- __ .�Q-._--__,.Distance to ryearest lot line--- ------------ [ff_,-r,,&tj Number of pits--------/-----------Lining material__' AX-_._.__Size: Diameter- _414o-4'-6.Depth-______------------------ Cesspool: Distance from nearest well----------------Distance from foundation._=—_--��'�""'"'.'I_ining material------------------------------------- Size: Diameter.-1 w ~"""`_.....:. , •. ❑ Depth - Li quid Ca Paci tY----------------------------gals. Privy: Distance from nearest well--.---------- -----------------------------------Distanc6from nearest building------------------------------ ---------- ❑ Distance to nearest lot line----------- ------------------------------------------------ Remodeling and/or repairing (describe):____ - _._-_ ---___ - ------------------------------a ----------• • ---•-------•---------------•_..--------------------------------------------------- ----- -- - ----------------- --------- ----------------------------------------------------(—.%, 0 -- ---- ----- ared this'applicationand that the wo-rTc ,"4ii .be.done i ac o dance with San Joaquin County I hereby certify that I have prep ordinances, State laws, and rules andM� ion 'of=+he San J oaquin Local Health isfrict. I t (Signed) --------------------------------------------------------------- ------------------------- ----(Owner and/or Contractor) BY ---------------------------------------------------- --------------------- -----(Title)---------- ----------------- - ---------------- ------ - -- (Plot plan, showing size of lot, Iota+ion:of system in relation to wells, buldings 'betc.jcanTl a placed on reverse side). ' FOR DEPARTMtNT;�IJS OILY,kkV*1`1 I APPLICATION ACCEPTED BY- . ,._70-t ------T--�,-.-------DATE--- REVIEWED BY------------------------------------------- -------------- - = DATE_-. BUILDING PERMIT ISSUED-------------------- .---------------------------------- ----—-------------------------------------- DATE-•- ---�------------------- ----- -----------------•------ I Alterations and/or recommendations:---- ---------- -- �, = �..- _ -------------------------------- �? _•�+' �� ----� -�----------------------- (' > ----------- ------------- - -----ift ------------ ------------------ ey -_ -; r----5---x---- ' '---- :" =-._ _ --- FINAL INSPECTI N BY: --- ------------------ - ---•--------------•------------------------ ---------------------- SAN JOAQUIN LOCAL HEALTH 'DISTRICT 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.C..