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l -__.�-�..�-•%/•-�- :APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _7 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 descrbed. This application is made in compliance with County Ordinance No. S49. --_--- ---•-------- JOB ADDRESS AND LOC TION__..-_____C��---�---- - - -• -- - ------------------------------------ _ Phone --------------------••---------•---- Owner s Name---- --------------------- -- ----- -- - Address'= .------------- -------------------------------•-----------------------•-----•---- Contractor's Name ---- ______-�'- -- - 4 --- Phone do Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1 ----- Number of bedrooms 2 ----Number of baths - ___.__ Lot size ____ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _�-['Jft- 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 public sewer is available within 200 feet.) Se tic'nk� Distance from nearest well_________________ Distance from foundation T� depth--------------- ---- Ca Capacity ---- No. of compartments --------------------------Size ------------------------------ p ty..-------------- ispo „j�jeld: Distance from nearest well ___________ Distance from foundation _____---__________--Distance to nearest lot line __________-.-____ Number of lines ------- --------------------------- Length of each line ---------------------- -Width of trench Type of filter material________ ----------- Depth of filter material _______-______ f_____ Total length ------------------- Seepage Pit: Distance to nearest well _----CfU-!l�_--Distance f om foundation lot to nearest lot line- v Number of pits-I_._�.__- "------Lining material--��---.Size: Diameter---..---------- Depth___��----------------- h t Distance from nearest well _---_"_______-_-Distance from foundation__. --"_____-______Lining material_.____ "----•--------------------- Cesspool:als. ❑ Size: Diameter--' ----------------------------------- Depth ---------------------------------------------------- Liquid Capacity---------------------- 9 ------ -------Distance from nearest building Privy: Distance from nearest welt------ ----------- ------------ 9------------------------------------------ Distance ------------------------------------- l ❑----------------------------------- C1 ----------------------- ` Distance to nearest lot line--------- ----- ----------------------- --- f� -----------------------------•------ }-------------------- Remodeling and/or repairing (describe):_-_ _ _ --� - -- ------ - --------------- f-------------------------------------------------------------- ------ ---------------------------------------------------------------- ---------- - - ----------------------------------------------------------- -------------------------- ----------- I hereby certify hat I have pre red t application and that the work will be done in accordance with San Joaquin County ordinances, Sta+ , a ules nd re ations of the San Joaquin Local Health District. Owner and/or Contracforl (Signed)---- - -- -- - -------------- --------------------- :. Sfao+. a -------------------------------------------------------------- showing size of lot, location of system in relation eNs, buildin tc., can be placed on reverse side). (Plot plan, g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 7 `--K-' 0--'----------------------"------------------------------------------- DATE---------- "---------------- REVIEWED BY -------------------------------------------------------------•----------- --------------------------------------------• DATE-----------------------------------•---------------------- -� BUILDING PERMIT ISSUED------------------------•------------------------------------------------ -------------------------------------- DATE---------------------------------------- -------------------- Alterations and/or recommendations: ,r-------------------------------------------------•--------•-----------•---------- •-------------- i. ------•-- gym.-�-----------------------------------------------------• ------------------- --------- 1-1 FINAL INSPECTION �� Date------- --------------------- -•-- ----------------- BY:. _.___ _ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. FS -9-2M Revised o-'59 F.P.Cc.