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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued This Permit Expires 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. �' - 7 -�(s- JOB ADDRESS AND LOCATION-- ------- ------- Owner s Name_._�_�_. __ " - -------------------------1. _$ Phone ° 01 ,�/ --------------------- Address---------44 --..= ---•----------------------�"�` Contractor's �--- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other A N F Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --1_ - - - ay Water Supply: Public system ❑ Community system ❑ Private I] Depth to Water Table S�o ft. Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [A New Construction: Yes No ❑ FHA/VA: Yes ❑ No El TYPE OF INSTALLATION ANCi SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance 'from nearest well--��-__---Distance from fo ndation_ ./;----------Material-___________________.._____.___---_____.-----.- a �,,�� Capacity s"g"i------ No. of compartments------ ---------------Size. {' s__r/ �%1q�'1liquid depth--- _----- - - Disposal Field: Distance from Nearest.well- +T_Q-------Distance from foundation..1_P----------Distance to nearest lot "...- Len th of each line--- -�----------------Width of trench_._, -'�:_----------------- Number of lines_._._..--.-- -- g --fDe th of filter material-__If_��--_____-Total length-- y of filter materi - p r , N . Seepage Pit: Distance to.nearest,w IL_.� '.�,-------Distance fro foundation____h-- `__-.Distance to nearest lot lin : - _3`s� ` -.Size: Diameter._-- Number of its--------------------Lining material _- p ' ' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------_---__.-_--------_..__-_-_-- ❑ Size: Diameter s'---•---------------------- -------Depth----------------------------------------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building - ❑ Distance to nearest lot 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 Coun ordinances, tate law and rules;and regulations of the San Joaquin Local Health District. -:' _._.._.----(Owner and/or Contractor] (Signed] --------------- ---- {O d/o r y - r y--------------------------------------------------------- T�tl P - - (Plot plan, Showing si of lot;location of system 1n relation to wells, buildings, etc., can be laced on reverse side]. f FOR DEPARTMENT USE ONLY DATE-- APPLICATION ACCEPTED BY: �------------------------- ?---.-L�_-__is--- ------------------------ REVIEWED BY--------------------------- - - DATE--------------------------- BUILDING PERMIT ISSUED--==----------------- --------------------- DATE-------•------------------------- Alterations and/or recommendations:----------------------- ------------------------------------------------------------------------------------------- ------------------------ ----------- ,... ------------------------------------------- ' --------------- tDate.. ------------------- --------------------------------- FINAL INSPECTION BY --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-`59