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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) o / I, Date Issued ------------- 1Sy 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_-_--- 1 --- • -------- ---------•-------------- Owner's Name--- tG. , r1� ---- ------ Phone. Address-___----____ Contractor's Name----- ------- �'� Gr------------------------------------------------------------------- ------------- Phone--- Installation will servei Residence ❑ Apartment House p Commercial E] Trailer Court ❑ Motel ❑ Other Z;—" Number of living units: Number of bedrooms _ -+_ Number of baths ---/- Lot size A �f/ " Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table `ff. Character of soil to a depth of 3 feet.- Sand ❑ Gravel ❑ Sandy Loam 0,Flclay Loam ❑ Clay ❑ Adobe ❑ Hardpan E] 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.) etic pvTan Distance=from nearest wellflr - _- Distance f1Fm foundation-_A0.--------Material-__ _ No. of compartments------A- -------------Size _. - - __Liquid depth----rJ� _ Ca acit __-90.69---------– ------- Capacity Disposal Field: Distance from nearest ell_ A'".Distance from foundation_1oo_........Distance to nearest lot tine--c�-_' Length of each line----- --------------Width of french---X:Pr" __._- O Number 'of lines---------_-•_-- --- - ------------ T e of filter mate ria <� Type ,� ------- Depth of filter material-----/�____-----Total length-----._ ------------------- ------ ------------------ Seepage Pit: Distance to nearest well-- ___----Distance from f ndation___ Q_ --.Distance to nearest lot line---± v---- [� Number of pits---- ----____---.Lining material- -_.5ize: Diameter-3 --------------- Depth--- ��---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------------------- F-1 _--.-.---------_------- ------- ❑ Size: Diameter----------------- :-- Depth---------.-------- ----------------------------------Liquid Capacity..--------------------------gals. Privy: Distance from nearest well----- ❑ --------------=-_---.-_____ _ .-..--__._.-Distance from nearest buildin g----------------------------------------- Distance to nearest lot line------------------- -----'---------------- Remodeling and/or repairing (describe)---------- -- -- - �_____ ___ Q' p • ! 'p-------`--Jt'��°'c� ------------- -------= - -----------•.--•-•-----------------••-•--- -------------- - --- -------------- ---------- ----------- ------------------------------------- ---- --------------------------------�------------------------------------------•-------------------•----------------------------------------------- � 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, a rules and regul ions of the San Joaquin Local Health District. -- (Signed) ------------------�er Contractor) - ---------- By:--•-------------------------------------------- --= I ) (T.+e of plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed on reverse side). FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------ ------ -- --- --------------------------------------------------------- DATE ............................................ REVIEWED BY ---------------------------------------------------------- DATE •------- BUILDING PERMIT ISSUED---------------------------------------------------------------- --------------------- DATE ---------------- Alterations and/or recommend ations------------- ------------------- .-----.-_-__---__-.__ ------------------------------•---------------------------------------------------------------------------------------------------------------------- - FINAL INSPECTION BY-- ------ ------ -. _ Date-fQ__ _' - -•- - - ---------- -------- 044 - ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132`Sycamore Street 814 North "C" Street Stockton,,California Lodi, California Manteca, California Tracy, California ES--9-2M Revised 1-57 EP.CO. 1