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<4 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �y This Permit Expires 1 Year From Date Issued Date issued •Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi application is made in compliance' with County Ordinance No. 549. JOB ADDRESS AND LOCATION----._1112' 1 r't s °� � "_ ----------------/41u---------..--_.----------- Owner's Name----- Z,_'!I � �!-• --- ------------------------- Phone------------------------------------ Address......... `- ��, r ��.. fw'--g-----ka Contractor's Name-----------------•---------- -------• -------------------------------------------------------------------------- Phone_-------------------------------- Installation will serve: Residence E] !Apartment House ❑ Commercial M Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------------------------------------------------__---___-_ Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑ Clay Loam ❑ Clay El -0 Hardpan ❑ Previous Application Made: Yes [-] No ® New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cesspool permitted if public sewer is available thin 200 feet.) Septic Tank: Distance from nearest well-._ev`-----__Distance from f, ` I P � p P ndation Material-_4__________ ____•---------------- - ------- No. of compartments _ p f � -------Liquid depth----a�---------- --- Capacity. Field: Distance from nearest well-A- ....-____Distance from i ndation---�p--_--------Distance to nearest lot line--J-'_-_----. to Number of lines------__f---- ---------------------Length of each ) 41-0------------------Width of trench----- -'------------------- Type of filter materiay p`_'__. Depth of filter aterial--_,��''--_---.---_Total length___..��..'-----------------___--_-__ °f ' { Seepage Pit: Distance to nearest well-------------_____Distance from i lundation---_____-----__--_-.Distance to nearest lot line_.______-_---- ' ❑, _ Number of pits----------------------Lining material--------------- -----Size: Diameter-----------------------Dept h-----------.__-___-----_---_-_ Cesspool:;, Distance from neairest well-__-------------Distance from ;undation---------_--------- Lining material--_____-.-..--..---.-_.---------_-_.-. I ❑ Size: Diameter------ -------------------------------Depth--------------- I --------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------- ---Distance from nearest building----.-.-_---..-------_--..______.-__.__. ❑ Distance to nearest lot line------------------------------------------ ------------------••--------------------------------------------------------------------------- Remodeling and/or repairing (describe) ------j----------------------------------------•-------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- .1 --------------------------------------------------------------- --- ------------- I hereby certify that I have prepared this application and that then ork will be done in accordance with San Joaquin County ordinances, St to laws, and rules n ,regulations of the San Joaquin Li al Health District. (Signed)-- --- -------- --------••- -------- - ------- - ------ ------- - : ' ----_____------------------------------------...(Owner.and/or Contractor) By:------ :------ - 1 ---------------------- Title (Plot plan, showing�ze of lot, location of system in relation to wells, bui ings, etc., can be placed on reverse side). FOR DEPARTMENT U ii ONLY APPLICATION ACCEPTED BY---- --------------- e * ' ------ REVIEWEDBY-------------------------------- ------------ ------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------- ------------- -- ----- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- ----------_----------------------------- -----------------------------------•-----•--------------•-----------•--------- --•-------------- --------------------------------•----------- ------------------------------------------------•----------------------------------•-•---------- -------- --------------------------------------------------------------------- ---- -------------------- FINAL INSPECTION BY:._f/L� --------------- -- - Date . i -------�------------ ----- � - - ------- ----- -- ---- --------- - ---- -- SAN JOAQUIN LOCAL HE' LTH DISTRICT 130 South American Street 300 West Oak Street 1132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I ES-9 2M Revised 6-'59 F.P.Co.