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FOR OFFICE USE: -------------------:1------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. 5 -------------------------------------------------------- (Complete in Duplicate) ------- / ---.-.--- This'Permit Ex ireis 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 compliarice with County Ordinance No. 549. JOB ADDRESS AND L8 ATION_-#- � (/ „�G / '- I -------------- - iOwners Name --'----- -------------------•----•--------------=-------------- ----•------------------------------- Phone------------------------------------ Address__.---•---------------- -------------------------------------------------------------- ----------•----------==-------------------------------------------•-------------------- Contractor's Name w - -------- -------•-•------ Phone.................:...........•--• installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: Number of bedrooms.,.__ Number of baths /_s-Lot size . Water Supply: Public system ❑ Community system ❑ Private•gDepth to Water Table/F ft. Character of soil to a depth of ifeet: (Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®/Hardpan ❑ R Previous Application Made: Ilt yes,date--------------------l No P-*'-New, Construction: Yes ❑ No 'g?- FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Seic�,Tank: C Distance from nearest well________________Distance from foundation------------------- .. Material___-___________.____.__________--..______._ .__- r/4f No. of compartments--------------------------size------------_-•.-_-------:----.Liquid depth Capacity q A DisposalfField: Distance from nearest well..�_fl_____:Distance from foundation-____._...Distance to nearest lot linea _".... Number of lines-------- --------__p__.______.Length of each line...----- Width of french...�_________________________ Type of filter material__/i1 1�?�.��Depth of filter material___f��-----Total length____ � ------------------------- Seepage _ _________________ `f 2 Seepage Pit: Distance to nearest•well------------------------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 �` ❑ 11 material_______.____-______.______ Size: Diameter " ._--_______ -------- -------------------- th------------------------------------__-_ Liquid Capacity gals.. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-________.________._____________-____._. ❑ Distance to nearest lot line--------R----------------------------------------------------------- ' Remodeling and/or repairing (describe).__________________ !l!Z --.----- ---------------------------•--------------------------•------ ------------•----------------=---------------------- -----•-•------- = - ------------------------------------------------------I-----I----------------------------------------------•- ---------------------------•------•--- ---------------------------------------------------------- -------------------------------------------------------------------------•-------------------•----...._.. -------------------------------------------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. l -------------------------------( br Contractor) (Signed)-•------------------ -- - -- ----- ---- - -- - -- = By:-------------- --•...----•-. • } - , (rifle) r ,�11 ---- ---------- ------------------ (Plot plan, showing size of lot, location of sy m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --------------------------- --------------------------------------- DATE-----------1 REVIEWED BY f ------------------------------------------------- -------------------------------------- DATE---•--------------••---------------- ------------- BUILDING PERMIT ISSUED---:__..--------_.. -------------------------------------------------------------------------------.. DATE.-------------------•---------------:------=----------------- Alterations and/or recommendationsi__________________________ — . 5 ------------------------------------------------------ --- ------------ ------ --- --- ---- - ------------------------------------- ---------------------------------------••--------------- ._--- - t `t • ` FINAL INSPECTION BY Date--.____-• Z G -----1 - --- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street f ' Stockton,California Lodi,California r• Manteca,California Tracy,California i� ES-9 REVISED 8-59 r.C.E[I.aM 6.60 f