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APPLICATION FOR SANITATION PERMIT Permit No. ...J. ---- ` • . / I {Complete in Duplicate} Date Issued,____I�/��1-�°--�-- 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 Ordinance No. 549. �/ q �.. ----------------------------------..._---------------------•---------------- JOB ADDRESS AND LOCATION --------�- ----`�--{-- ---------------------------------------------- ____ Phone •--------- Owner s Name------- ------ Address-- - --- ---- - - --- - ------ - -•--•-------------- � /�, � �O �/_ --------- ] --------•----------------- - ------------------------------------------- Phoney/r_9_.• -7... Contractor's Name_____, !----- - -- - - --- - ---� - ------- Installation will serve: Residence [&-`A—partment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other [Is Number of living units: _/__ Number of bedrooms _a -- Number of baths _/-- Lot size ..... -------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth'to Water Table ;__ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No B_*,�New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No C1 TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.)., $pOfi' rik: • Distance from nearest well________________Distance from foundation-------------:-____.Material------------------------------------------------- No. of compartments------ ----- Size------------------------ ------Liquid depth-f-------_-------------Capacity---------------------- ` lA Distance from foundation___ ` Distance to nearest lot line___ ___._...- Disposal Field: Distance from nearest well/w - .-: �-�-------- �� Number of lines_-_____;__i I _ _ Length of each line-----A.&'---------��---Width' oftrench___��--------------------- O Type of filter maternal l-___Depth of filter material_----f-r Total length---------3_d9------------------------ Seepage Pit: Distance to nearest well _ _-Distance m f undation__-/Q_1._____.Distance to nearest lot line__e..s.___-_____ _-Size: Diameter-- �`0-- ----Depth----a.5- ------------ L'T Number of pits::_________-_.'__---Lining material_ __ _ ._ __ �i Cesspool: Distance frorr4nearest well__-----------------Distance from foundation -------------------Lining material-_____________________________________ ❑ Size: Diameterti-------------------- -----------------Depth--- ----` ---------------------------------------Liquid Capacity----------------------------gals, rn i Privy: Distance from.nearest well-------------------------------------------- - -Distance from nearest building_-__-------Y_____._____------.-------.- ❑ Distance to nearest lot line``----------------------- -------------------------------------••-------------------- 4 1 Remodeling and/or repairing (describey:�_------- ----------------- e _____________________________________________________________________________________________________---------- ---------_ .v ----------------------------------- --------------------------------------°------------------•-------------------------------------=--------------------------------------------------------------------- y-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Statv laws, and rule nd regulations of The San Joaquin Local Health District. �` ------------------------------ n -`� Ower and/or Contractor) (Signed)..------- ,-�.�t�'r------ 1 J ------- -------••-------------- i _i,.�l --------------------(Title) — --- --------------- ---- -- ---- -------- tPlot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t ----•------------ - DATE_,Lf= BY__� --�---t-- -�-�w �- - -� -- APPLICATION ACCEPTED REVIEWEDBY------------------------------------- ------ DATE-------------------•------------- ------- ----------------- BUILDINGPERMIT ISSUED--------------------- ---- --------------- ---=--- DATE--------------------------------------------- --------------- Alterations and/or recommendations:-- ---------------------- - - -------••------------•--------•---• -------- ----••------------------ ------------------- - ------------------ -- FINAL INSPECTION BY:---- �{ Date-_. - 6-a--.-. ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 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.Q.Co. -