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APPLICATION FOR SANITATION PERMIT Permit No. ....................... (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued j 2_-�1_o / ............ Application is hereby made to the San Joaquin Local Healfh District for a perrpjjj,9 construct and install the work herein described. This application is made in compliance with County Ordinance No. 544.�� L 40 JOB ADDRESS AND LOCATIO - " g� Q ------- f Owner's Name------------- ---- {... r � �• - -- --•--- Phone---------------- .. Address - ... -�_Z� - � ------------------------------••-----•---•-•-----•------ Contractor's Name------•-•-------- •--------- - --- Phone------------•--•--•------ Installation will serve: Residence Uk-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --t �t umber of bedrooms .__f_ ------Number of baths __/__ Lot size ----- -- _�___________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table '_2jft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic is available within 200 fee;) ..�: Septic Tank: Distance from nearest well_yis. ----Distance yfrom foundRn-1d_____.___.__.Materal____ ✓__ ____. JgJ No. of compartments--------.�^____�___.__.__Size__.-i�.--�__�-�--�-_Liquid depth-------�------------Capacity_____�ia__<�_._. � Disposal Field: Distance from nearest wei€.-�„t:.1 Distance from foundation_.M stance to nearest lot line___. __.`Y1n..,, Number of lines ---- Length of each line_______ L _ Width of trench__--_ .��_ o Type of filter material-----At_� Depth of filter material-_--_--/_ -----------Total length-__.----_ _,Q_-_____________-____. N h Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------:__.Distance to nearest lot line______________.__ ❑ Number fof pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance fi-om,nearest well_________________Distance from foundation------------------- Lining material-----------------------------_-______ ❑ Size: Diameter------------------------------------.Depth--------------------------------------------------_Liquid Capacity----------------------------gals. Privy: Distance from nearest we1L________________________________________________Distance from nearest building--------------------___________._._____- ❑ Distance•to nearest lot line------------------------------------------------------------------------ ----------------------------------------------------------------- �p Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ----------------------------------------------------------------------------------------1-1------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- I •--------- -----------------------------------------------••---------------------------------- 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, an rules agW re tions of the San Joaquin Local Health District. (Signed)___ 1 -------------------------(Owner and/or Contractor) By: -----------------------------------------------------------------(Title)-- rll -----------. ----- ---...-------- � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F PRT 'ENT S ON APPLICATION ACCEPTED BY-- - ------ -------- --------- ------------------ ---------- DATE-•-- ,al�h ----------------- REVIEWEDBY----------------------------------------------------------- ----------------------------------------------------- DATE ---- ---------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------•---------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------------------- --- ---------------------------•-------------------------------•---------------------------- --------------------------- --•----------------------------------------•------------------------------------------------ ------ ---------- ---------------------------------------•---•-------------------------------------------•--------------- -------I--------- ----------- ------------------ ---- -----------I-------- FINALINSPECTION BY------------ - -------------------- Date---- ----- -----------4--.-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2N4 Revised 8-'59 F.F.Ca.