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APPLICATION FOR SANITATION PERMIT Permit No....�1.0---- (Complete in Duplicate)Date issued ---- ��/d`d_-•d This Permit Exiiaires 1 Year From Date Issued 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. ..a JOB ADDRESS AND LOCATIO _ _ -� ------ --- -------------- Owner s Name___________________ --A�--- F --------- -- --- --- -- P�----------------- Q - --- Address 1._._..... I Address-----------------------•- / -- Phone --------- ----------•-- Contractor's Name------------------------•------------------------------------------------------- Installation will serve: Residence [Apartment House [ICommercial ❑ Trailer Court ❑ Motel ❑ ,,Offther ❑ Number of living units: --/-- Number of bedrooms- Number of baths /____ Lot size .-j--- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 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) Septic Tank: Distance from nearest well_ -'"stance from foundation_/P`Materialr___.-w�--" - ---- I' y -----Size_/ Liquid de th__ •. --------- Capacity.------- Na. of compartments ________-.--- �--X --�-�"'X---- - q t p� ; Disposal Field: l Distance from nearest well__�74 ``7 stance from foundation-/_. Distance to nearest lo# line- '1x4 _ _.__ __Len Length of each line-"-' of firench-__.• .rf� 1---.------ Number of lines ________,--__'' - 9 iI Depth of filter material__ _ a�-____.___Total length___ -____.>Q ----------------- Type of filter materiaUK l___ _--_ - p �` Seepage Pit: Distance to nearest well ------- 4------------- Distance from foundation -------------------- Distance to nearest lot line ----------------- ❑ -Number of -pits ---•------------------ Lining material Size: Diameter # Depth_ Cesspool: Distance from nearest well ----------------- Distance from foundation --- ----------------- Lining material____--__-_____.____.___.______els. ❑ Size: Diameter--------------------------- --------- Depth --------------------- -=-------- ------------------Liquid Capacity ----------------------------9 Privy: Distance from nearest well ------------------------------------ -------------Distance from nearest building ------------------------------ .__.--.---- ❑ Distance to nearest lot line -------------------------------- I Remodeling and/or repairing (describe): -------------------------------------------- Y ------------- ---•-------••---------------------------------------------------- ------------------ ---------------------------------------- ------------------------------------------------------------------------ ---------------------------- i-------------------------------------------- -------------------------------------------- ------ ---------------- --•--------------------------------------------------------------- t San Joaquin ons of he---------------•-------------------------------------------------------------------------- I hereby certify that I have prepared this application and that fhe work will be done in accordancet with San Joaquin County ordinances, State laws, and rules and regulations q in Local Health District. I _ � (Owner and/or Contractor) -------------------- ----------------------- [ 9 By:�---------------(Title)-------� - ------ ---- (Plot plan, showing size of lot, location oftsystem in relation to wells, buildings, etc., can be placed on reverse side). APPLICATION ACCEPTED BY --- _ -_�_ �- ��---------- --- DATE --- REVIEWED BY----- -------------------------------------- --------------------------------------------------------- DATE------------------------ ---------------------------------- ------------------- ---------•-------------------------------- DATE. ------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------- --- Alterations and/or recommendations: ---------------------- . ----------- --------------------- ------ -------------------------- ----------------------- ------------------------------- ---------------------------- FINAL INSPECTION BY:---- .,------------------- Date ------------ -- -------- i USAN JOAQUIN LOCAL HEALTH DISTRICT r 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. I ES -9-2M Revised 0.'59 F.P.Co.