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APPLICATION FOR SANITATION PERMIT Permit No. /Y (Complete in Duplicate) -0 +� This Permit Ex fres 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. ,rG JOB ADDRESS AND LOCATION_.• ------ -- /-- --- ''''-.'!___ Owner's Name-------- t -----�/_? ------ Phone--------------------•------ f ----------------------------------------------- A dress •-------------•-•- -�.. Phone_ Contractor's Name------- _ ____ . �� - - --------------- --- Installation will serve: Residence �partment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___/_ Number of bedrooms ___Number of baths _/___ Lot size ____-7-J0 7-X---ZrZ?---------------------- Water Supply: Public system ❑ Community system A Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe s Hardpan ❑ Previous Application Made: Yes ❑ No X 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 Tank: Distance from nearest well____ -. istance om f undation_--- --------Ma#eriaI_._.. IRA No. of compartments_.___-_.__ ize_____�o+� p ----------------Capacity- Z? � ' ---------- ______-Liquid de th_ �" Displ Field: Distance from nearest well.-.-- �� ?uistanee rom oundation___. Q--------Distance to nearest lot line--- Number of of lines---------- --- -------------- Length of each line-----------------__--- ----- Width of french-----Z-_!-_'�-_---.--_ _--- Type of filter material-_.Depth of filter material - -----Total length__---CPO__----_• ( , Seeps e Pit: Distance to nearest well Distance from fo ndation______ / - -- �!�-_.._.Distance to nearest lot line___.___._ K Number of pits-------/------------Lining material--- �---Size: Diameter------3�'--.--Depth---- _! Cesspool: Distance from nearest well-________________Distance from foundation----------------___.Lining material-______--_____---__-_____________._. ❑ Size: Diameter--------------------------------------Depth---------------------------- - -----._Liquid Capaci#Y ----------gals. 1 - ------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______ --------------- ------------ El Distance to nearest lot line--------- ----------------------------------------------------------- --------------------------------- Remodeling and/or repairing (describe):-_____-- _-__-._ -----------------------------------•---------------------------------------------- --------------- ------------------------------------ --------------------------------------------------------•------------------------------------•--------------------------------------------------------- -------------------- --------- 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).---_-- �_/_ -- __-- --------- (Owner and/or Contractor) -------- ----------- By:---------------------------------------------------------------------------------------------------------- --- Title ............. - - ----------- Pot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A -- -- -------------------- ---------------------------------------- DATE-------- - �" Z REVIEWEDBY----------------------------------------------------------- - ------------------------------------------------------ - ---- DATE---- --- -- -----•--- ---------------- ------------------------- UILDING PERMIT ISSUED----------------------------------------------------------•----------------------------------------- DATE--------- Alterationsand/or recommendations:_________________________ --------------------------------------- ------------- - --------- �/�- -� ........................... - ----•--------- -------------------------------------------------------- ---------------------- FINAL )NSP TION BY:- ------ - Date 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.Co.