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APPLICATION FOR SANITATION PERMIT �ermit No.`--_:_.a........ (Complete in Duplicate) le f y This Permit Expires 1 Year From Date Issued Date Issued -_______�s/r_Y' Application is hereby made to the San Joaquinn,.�Local Health District for a permit to construct and install the work herein described. This application is made in compliance with oi i ante No. 549. JOB ADDRESS AND � LOCATION _ -- A L G " ------------------------ -------e-- ---------- A Owner's Name- • --- - --------------------------- ------------------------------------------ Phone--------------------------------•--- Address--••- Rr Contractor's Name ----------- -------- Phone----------------............ Installation will serve: Residence me ous} Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___)__ Number of bedrooms .__Number of baths -------- Lot size i._ _.�a___C_.___ _________________�;,,:,��__� Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ----- ft. )4 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 iso a within 200 feet..) Septic Tank: Distance from nearest well Distance fro foundat _-_/_l1__ .Mat�ri -��-- ------ No. of compartments..__` _ :_-_--_ __Size__-_____ __'Liquid depth _.__ - Capacity-___. _: ___ Disposal Field: Distance from nearest well �7t �QDistance fr�fqun ti .__.Distance to nearest lot lin Number of lines-------13- Length of eh?1jiid.=_ �f_.�VVth of trench C.. Type of filter material_._.T_ _ Depth of filter material_.__._. ___ Total length___.__ ._ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F-1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth____-___-_____._-.________-- } Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------.______--_- ❑ Size: Diameter----_- ----- Depth--------------------------------------------------Liquid Capacity----------------------------galls. Privy: Distance from nearest well-------------------------------------------.-----Distance from nearest building________-_-._._-_-______--_.-____. ❑ Distance to nearest lot line--------------------------------- - - - - - Remodeling and/or repairing (describe): , _____-_--__-_-_-. r i/ {} rs - � C------------------- ----------- --------------------------_ -__--_--__-___---__-____-_____--_____----________-_-_-_---_______________-._-___-____-_-_________-_____________________.___-_____-_____-____________._-.__--_____---__--_-.-____-.._____ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinagces, State laws, and r es regul i ns of the San Joaquin Local Health District. - - (Signed)------ ---- .._ (P - ---- - ----- '- -------------------------------------------------------------(Owner and/or Contractor) By:•------------------------------------------------------------------ ------------------- --------------- ----------------------------(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 APPLICATIONACCEPTED BY------------ ----------------- ----------------------------------------------------------- ----- DATE------------------------------------------ --- ?T_ REVIEWED BY - -- ----------- --_ DATE------- BUILDING PERMIT ISSUED--- - :.� ��r = DATE - --- Alterations and/or recommendat 6Wr-_____-------------_------ ------------------------------------------------------------------------------------------------------------------------ -------------- ------------------------------------------------- ------------ --------------------------------------------------- --------------------------------------------------------------- -------------- --------------------------------------------------------------- -------------------------- ------------------------------------------------------------------------------- ---------------------------------------- -------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------- ----------------------------•----------------- -------------------- FINAL INSPECTION BY:-- -- ------------------------`-- Date------ -------------------- SAN ------ ---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.