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t APPLICATION FOR SANITATION PERMIT Permit No. .. ........... (Complete in Duplicate) Date Issued _____________________ k This Permit Expires 1 Year From Date Issued I 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 LOC TION..._ .__ l - ---- /// Phone. Owners Name- ----'-- �!tm Address----/ -1 --- - --- ---••---- ---- ----- --- --------• --------------�----------- Phone _Contractors Name__---- ---------••-----•---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ TrailerCou�t'❑ Motel ❑ Other ❑ ,5'a Jl; .1 9, b Number of living units: -_l___ Number of bedrooms -5--- Number of baths __I___,,Lot size _____________"_.. ________ _ "_________________________ I1, I Water Supply: Public system 91 ommuriity system ❑ Private ❑ Depth to Water Table - - f. Character of soil to a dept%) of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L4 Hardpan ❑ Previous Application Madei i Yes [-] No F-1New Construction: Yes ❑ No [:] FHA/VA: Yes F1 No Elf TYPE OF INSTALLATION,AND SPECIFICATIONS: (No septic tank or Aisspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance cb from nearest well__.�?Yq_Distance from foundation__ _Q r _ __.Material_.___/./Ps--�--� --" -;---------- No. ofl�com'Compartments---- - ----------Size___, `X-- - - Liquid depth___--�_.______..--Capacity-. QQ--. - p Disposal Field: Distancle from neares ell.._._______._Distance from foundation__1Q�__________Distance to nearest lot,line_�____�__._.. of lines_____ _____________Length of each kne____ a*�-'--------------Width of trench---- Number _ --"""-----f-- .a Type of filter materia_'_1�zC�L---------Depth of filter material__J�'__------------Total length__i_"�__.,�, - ----- -� __.Distance to nearest lot line `_____.. Seepage Pit: Distance to nearest well _____________________Distance.from oundatior ._.___ _- \ Numbeli of pits ___ ._.Size: Diameter-- W. __ ._------ yX -____ ___-_Depth _6_____---------------- CessolDistance \ . from nearest well_________________Distance from foundation___._.____._----__..Lining material-___._______--_________.__.______-._ V 0 Size: Diameter-------------------------- -- --------Depth_---------------------------------------------------Liquid Capacity----------------------------gals. i Illl Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------------- - ------------------------------ ---------- Il•� `I\ IIS I . Remodelingand/or repai jng {describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- ----------------------------------------------------------- -----------•------------------ --- ------------------------------------------------ I -------•-•--------------------------------------------------------------------------------------••---------•-------•------------------------------------------------------------------- - ------------ --- I----------------------------- - ---------------•------------------------------------------------------- -----------------------------------•--------------------------------- -------- -------------- - - ------------ - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelaws, and ules an regulations of the San Joaquin Local Health District. (Owner and/or Contractor) • . -Idl--------- (Signed)-. -i Title (Plot plan; showing size o_ lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY i� APPLICATION ACCEPTED BY-------------------- ` DATE - ----_-- - -------------------------------- REVIEWED BY------------------IIS---- ------ - --=-------- DATE----- - - ---- --•---------------------- ----------------- -------------------------------------- BUILDINGPERMIT ISSUED--------------------------- ----- --------------------------------------------- DATE Alterations and/or recomiendations------------------------------------------------ ---------------------------------- :II ----------------------- ---- -------------------------------------------- ------------------------------------------- -----------------------� I-- ----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------•----------- - II -------------------------------------------------------------------------------------------------------- --------------------------------------------- -I -------------- ------ :II: ------------------------------------ 6a FINAL INSPECTION '. •-- -- =�� -�r --- - ------------ Date_..." ------�----- - --------------- --- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, Californias ' Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P!Co.