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APPLICATION FOR SANITATION PERMITz -. Permit No. __�_.......__°_ (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued —Ak iV2 [3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork _eapddees-cribed. This application is made in compliance with County Ordinance 549. JOS ADDRESS A LO TION... -------------- ------- led- Owner's Name Phone " - - Address =�" ------------ - ---------------------------------------------------------- ------------------" -------- Contractor's Name--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail r Court ❑ otel /O� Number of living units: ---T Number of bedreoms _--f Number of baths ---� Lot size ____ — ----------Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _. __ ft. Character of soil to a depth of 3 feet: San ❑ Gravel E] Sandy Loam E] Clay Loam [jClay [-] Adob Hardpan E)Previous Application Made: Yes'❑ -NoNew Construction: Y94 No E] FHA/VA: Yes E] N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. -- - -- - - ----- Septi Tank: Distance from nearest well____Dista lIfrom f n tion._.__ Material- No. of compartments_t.=___________Siz --Li Liquid depth aci i g P P tY Dis al Field: Distance from nearest well. Distance from foundatio _._ ____.Distance to nearest t life____ Number of lines___�,r_____ 1„ "--- ength of each line---- �/--Width of trent ..�--------------------••- th of filter material__ 9 Type of filter material_�_.._1i�p -•""-----Total length (7--fol Seepage Pit: Distance to nearest well---------------------- from foundation-------------------Distance to nearest lot line______.._______._ { , ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--- ----------------------------- Cesspool: Distance from nearest well____ _ _ _ __._____-Distance from foundation-------------------- material--------_--.______________-----.____. ❑ Size: Diameter--------------------------------------Depth------------- _._---------------------------------Liquid Capacity-----------------------_.._gaffs. 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 reguiat�s oft San Joaquin Local Health District. _____________ (Owner and/or Contractor) (Signed) ---- ;• '. ---------------------------------------------- Tale By-------------------- (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------- --- -------------------- -- REVIEWED BY-------------------------------------- -- --�-- ------- ------------------------------ DATE_"__ -- ---- ---- -- •---------------------- BUILDINGPERMIT ISSUED----------------------- ------------------------------------------• DATE--------- ---------- ------------------------------------- Alterationsand/or recommendations-------- - ------------------------- -------- ------•----------------•--------•--------------------------------------------•------------------•------------- - - -------- ------'° ------------ G�o ----•-- --- _ -------------- ------------------ - - --- ---- ---------- - -----------------� ,. -y',�,•------- " r '� 6 ea. �l.-: ' ` �" ----------- FINALINSPECTION BY-------------------------------- a e------ ----------------------- ------------------- -- - ---------------------- <<'. SAN JOAQUIN LOCAL HEALTH DISTRICT SoufH �m r can 5tree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi. California Manteca, California Tracy. California ES-9-2M Revised 6-'59 F.P.Co.