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0 F APPLICATION FOR SANITATION PERMIT hermit No. . (Complete in Duplicate) Date Issued --cj_--�s•�J This Permit Expires 1 Year From 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 na. No. S49 JOB ADDRESS AN CATION_______________ _ r ,i Owner's Name--------- -----------•--------------------- ----- --------------- ---•------- -------- Phon--e. d-'1-1-- Address----------------- ---- -.--•---------•----------------------- Contractor's Name--------•----------------•-----------•---------------•-------------------••---------- ---------------- --------•------------.. -------------- Phone.........--•---------------------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --------------------- Number of living units: ----- Number of bedrooms _3._ Number of Baths --'J----Lot size ---------- - ••-�+3• Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I- Hardpan ❑ Previous Application Made: Yes ❑ Nom New Construction: Yes 1�. No ❑ FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well_______________Distan e fro clation____.� -_____.M t riaL__ ____ _----___._._______ _-_ No. of compartments-------7�-------Size--- Ze ------Liquid deRth .-�---------.----Capacity---- --------- Disposal Field: Distance from nearest ------Distance from foundation___--(®______.Distance to nearest lot line-____ I -------- - Number of lines.._.______�t __ ___________Length of each line----sS- -_----.Width of trench--- th of filter material____.__ Total length______- Type of filter material- i- _ Seepage Pit: Distance to nearest well_'________.__------Distance from foundation-------------------_Distance to nearest lot line----------------- ❑ Number of pits---------------------Lining material----------- -----------Size: Diameter.---------------------.Depth--------------------------------- 11 Cesspool: Distance from nearest well-----------------Distance from foundation------------.------ Lining material___.-------__-.._____-----.__.____Is Si :zeDiameter--------------------------------------Depth---------------------•----------------------------Liquid CapacitY----------------------------ga . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__..___________-.- ___________..-. ❑ 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. - ---- ---- - ---------------- -------------------- ------- ------__ ___(Own and/or Contractor) (Signed)---- --------- ------------------ - -------------------------------------------------------- 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--------: ------------------------------------- DATE----------- REVIEWED BY DATE BUILDING PERMIT I�SSUED------------------------- --------- DA ..... --------------------------------------------- Alterations and/or recommendations----------------------------- ---------------------•--------•--------- •---------------------------- -------------------------------------------------------------------------------------------------------------------------------------- --------- -------------------------------------- - ----- - --------------- ------- --- ----------- ------------------------------------------------------------------------------------------------------------------- FINAL INSPECTI Q- -------------- ----- ---- 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-92M Revised 8-'59 F.P.Cu.