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APPLICATION FOR SANITATION PERMIT --a Permit No....Jf`f....... (Complete in Duplicate) - 0 (-�install ate Issued .._.7l x. .G1-1 This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin'Local Health District for a permit to co ct an he work herein described. This application is made in compliance w' h County Ordinance No. 549. JOS ADDRESS AND LOCATION ---------------------------- -x•---` 4------------------------- ------•- _.__- —: Owner's Name-------------- C- z -k ------ �PQ-- �`= - -----------------------• ------- = r.- Phone ----------------------------- .------ �c vwL� _._..- ------------------------------------------------- Contractor's ----•----- Contractors Name r ------------------- ----- Phone.. Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ___ Number of bedrooms _> ____ Number of baths __)----- Lot size ____ ____________________________ Water Supply: Public system yE] Community system [�Private g[ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel r] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0, 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 nf well________ _____- No.ocompartments Distance ------------------r- Material ------------------------------------------------- i----------- Liquid.depth_................... Capacity Disposal Disposal Field: - ___Size Distance from nearest well.._1_Q------ .foundation __.___ ---________.______------- Distance from foundation_________ ---------- Distance to nearest lot line --- ._________ ,>✓° Number of lines__________ ___. �_______ L"ength of -each line_L fa _t_��'a__._.Width of trench___- ii___,_____________________ �] Type of filter material____rD�____ Depth of filter material__ IQ________ -__._Total length_____a�'_____________ ___ p__+---- See a e Pit: Seepage p g restelL___(---�-t--g ),�I �_. - - - -- aal ��f ndaTeonDia ' Distance to nearest lot fin _-�_____ Number of pats mDte t� -------V° titer - '- Depth' Cesspool: Distance from nearest well_________________ Distance from foundation --------------------- Lining material _______._..___.___.____________.___. ❑ Size: Diameter-------------------------------------Depth --------------------------------------------------- Liquid Capacity ---------------------------- gals, Privy: Distance from nearest well ------------------------ ------ _____------------ __Distance from nearest building __________.___._________________.._____... ❑ Distance to nearest lot line. `--------`------------------------ •----------------.------------------------------------------------------------- /" f Y � Remodeling and/or repairing {describe]_ ------- __------- _......... -- -------------------------------------------------------------------------- - - _ -3 -----------------------------------------------------------------------------------------------•------------------------------------------- -- ------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. R - (Signed)--�--- = ]Owner and/or Contractor) By:----------------------------------------------------------------------------------------'------------------------------------------(Title)----------------- (Plot plan, showing size of lot, location of.system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY. APPLICATION' ACCEPTED BY --------------- ----- DATE------------------ ---------------•------------------ ---------- ----- REVIEWED BY---- .------------------------------------------- DATE----- ------ - ---- --------------------------- BUILDING PERMIT ISSUED ------•---•------------------h----------------•------------ •----------------------------- .- DATE------------- - ---------------- ------------------------ Alteration and/or recommendations: f r ---------------------------- -------------------------------------------------------------- ------------------- �i FINAL INSPECTIO ------ Date---- 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 E5 -9-2M Revised 8-'59 F.P.Co.