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APPLICATION FOR SANITATION PERMIT Permit No. l.... (Complete in Duplicate) Date Issued ----- --`---f-- 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. JOB ADDRESS AND LOCATION... r 'L--------- ------------------------ Owner's Name_____ __ ______________ Phone.____.____ ------------------------ --- Address `�� / /+ Contractor's Name �S a------r ------b�� ` _. - G< Phone, E� � Installation will serve: ResidencKumber Apartment House E] Commercial E] Trailer Court [:] Motel ❑ Other ❑ Number of living units: _�`_ of bedrooms .;�f�Jumbx erof baths /_____ Lot size ____ ______ ---------------------- Water Supply: Public system E] Community system El Private Depth to Water Table24- __tft. 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.) pt'cTank: Distance from nearest well- _.t_Distance from foundation---/9---______.Material----- .l_C ------------------ No. of compartments------._2l--___.___Size_G7_X----�PS_____:___Liquid --------------Capacity___t-FO__0____ Dis os I Field: Distance from nearest welf_,t_____Distance from foundation-----?,--------Distance to nearest lot line__~______ Number of lines______ 7r� {{--------------------Leng}h of each fine----`�--d__X---��-----Width of french-----«7--- =-------------------- Type of filter of filter material_____ ___________Total length___._S:Q___________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-________________ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- V Cesspool: Distance from nearest well-----------------Distance from foundation.-- -------------- material____-_______________.______.________. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance ___---__---_----------_____---__-.--- -.Distance to nearest let 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, aA rules and re 'ons of the San Joaquin Local Health District. 1 -�� `■ �---------------------------(Owner and/or Contractor) (Signed)------------------- By:--------------------------------------------------------------------- -t- - `/ (Title)---- � ' ----------------- -- - -- - - -- - (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- ---- ---- -- ----- --------- ---------------------------------------- DATE------ REVIEWEDBY---------------------------------------- `--- -------- --- ---- - - --- -- -- ------------------------------------- DATE -?---- = ------------- . BUILDING PERMIT ISSUED---------------------j--- -R------- ---- - -- - ------ -------------------------------------- DATE------------------------------------------------------------- --- Alterations and/or recommendations:-- --- ------- ------------------ --- ----------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------- --------------------------------------------------------------------------------------•----------------------------------------------•_-------------- FINAL INSPECTION BY: --- ---- --------___-- -------------------------- Date_ -{ '--- - -~-- - 5--- ------------------------------------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, Italifornia Tracy, California 8-9--2M Revisea 1-57 F.P.CO.