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APPLICATION FOR SANITATION PERMIT Permit No. ' r(Complete in Duplicate) This Permit Wires 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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_ ______ � ---------------------------------------------- --------------X1 •------------------------- -••-- Owner's Name --- - f - .................................. Phone-� i_ -------•-----------------•----------- .... -- Add ress------------- Contractor's Name-------------------------- _ .__ t P ' ' ------•--------i hone._ ------ Installation will serve: Residencepartinent House ❑ Commercial ❑ f Trailer Court ❑ -Motel E:1 Other El Number of living units. _ gNumber of bedrooms _07- Number of baths - -- Lot size .-S •,�. ..,4 _______________________________ Water Supply: Public system Community system E] Private E] Depth:to Water Table V-O- ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam E] ; Clay Loam E] Clay ❑ Adobe Hardpan ❑ ❑ Previous Application Made: Yes 1 No [ NewoConstruction: Yes ❑ No ��FHA/VA: Yes [], No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:a .1 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A *in Distance from nearest well________________Distance from foundation_________ _-______Materiaf_-______-_______-_._-.____--_----------------No. of compartments------- ------------------Size--------------------- - i-- _. _ Liquid depth---------- ----- ----- CapacitY---------- ---Distance from nearest well_ . Distance from foundation..1Q--�---..Distance to nearest lot ne_-�-.Number of lines_-___-_�_____________ _____ Length of each line-------- of trench.-__ ___0/_�-------_ / ---------- Type of filter material----:5' __ . - Depth of filter material-----�F- _8-- Total length- ' --- --------••------- Seepage fit: Distance to nearest well��-Distan o un ion___-p�_�-_�_-.Distarce to nearest lot line.?!-_ LO ` / --- Number of pits_-I.___J----- -----Lining material- ize: Diameter_--.33-------------Depth----°Z ----------------------- - --------- _ Cesspool: Distance from nearest well-----------------Distan from f ndation--------------------Lining material----------------------------------- .. ❑ Size: Diameter--2-11--------------------- ----------Depth--------------------------- Liquid Capacity gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building ❑ Distance to nearest lat line----------------- --------- Remodeling and/or repairing (describe)___________________________________ --------------------------------------------------------------- I _____________________ I hereby certify that I have }5rel ared this`appIicatian and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. { ) (Signed) 5 - Owner and/or Contractor) Z��------------ ------ -------- ------ --------- - - - ------------------------------ --- BY:------------------------•' = -- -- (Tit le)------ -------------------- ot plan, showing size of lot, location of system i lation to wells, buildings, etc., can be placed on reverse side). 1 R DEPARTMENT USE ONLY , . APPLICATION ACCEPTED BY_ -.-.�.-t- i r - - - - - - - -- ---- - ------------------------- DATE__- ��--`�-��---��-'---�-------------- ---------- DATE_._.- ---------------- - UILQlNG PERMIT ISSUED F- � ------------------------------------- AlterationsDATE ---------------------------------,s ---------------- and/or recommendations:- _---------------__________.__ ' - ° l _____________________ ---------------------------------- ------------_---------------------_____------------------ .----------------.-------------------------------------------------------- FINAL INSPECTION BY Date-----7/l/ 2- 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 a ES-9-2M Revised 8-59 F.P.Co.