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rt APPLICATION FOR SANITATION PERMIT Permit No. ..... SAr `.w .. ,.. E(Complete in Duplicate) 6 !� Date Issued ---_ 131-.-.. 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. JOB ADDRESS AND LOCATION------------ ------ ___________ ___ -------------------------------------------------------- ------------------- Owner Name-- Address-------------------------------5 ame-Address-------------------------------5 ;sIwevv�. Contractor's Name- ------------- --------------------- - ----- ------------ ---- ----------------------------------------------- PhoneL---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court, ❑ Motel ,0. Other [j f �, Number of living __ units: ___ __ Number of bedrooms __Pr --------2_ Numbeof baths _ _____ Lot size5____�.___� -------------------- Water Supply:� Public system ;I Community,system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe.[ Hardpan ❑ Previous Application Made: Yes E] No New Construction:' Yes o FHA/VA: Yes n No g- k ' 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_ 64/g�-__Distance from foundation__._f0-__-__-_.Material/__ ---- __ _ __ _ ______________ f No. of compartments________ _____________Size____f_ - -,2 _ _Liquid depth-----____.._ ----------Capacity--------90 Disposal Field: Distance from nearest well_1P�O.i7/'4.�,.Distance from foundation------/.'�__''_----Distance to nearest lot line--. p �-�¢ � ] Number of iines_________a _-- __ Length of each line-----_----8e'___-_..____-..Width of french----------,-I-�_ Q' Type of filter mat erial-_ Depth of filter material-------/r1_ Total length------------A-0------------------ Seepage Pit: Distance to nearest well-----___--------------Distance from foundation-------------.-----.Distance to nearest lot line----------------- I Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Ips Cesspool: Distance from nearest well_____,r_--------Distance from foundation--------------------Lining material------.__________________.__.______- ❑ Size: Diameter------------------------- - --- - ----Depth----------------------------------------------------Liquid Capacity-------------------------•--gals. Privy: Distance from nearest well----------_-`.------- -------------------------Distance from nearest building-------------.-_------_______.____._____.. j ❑ Distance to nearest lot line--------------------'------------------------------------------....-•- Remodelingand/or repairing (describe):--------------------------------- --- ----•--------------------•--- ----------------•-•------•--•-----------------------•-------------------------------- -- - ------------------ ------------------------------------------------------------------------------------ ---------------------------------------------------------------------------- ------------------------------------------------ -------------------------------- - -------------------------------------------------------- _ --------------------- ------------------------------------ { k — k ,I hereby certify that I have prepared this application and that the work will b'e done in accordance with San Joaquin County ordinances, State laws, and rules and reg - ulafions oft San Joaquin Local HeAh District. I <� (Owner and/or Contractor) �y�� - --------------------------------------------- (Signed) -------"! By:---------------------------------------------------------------------------------------------------------- --------------------(Title)--------------------- ------ ----------- ----- -- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPO$TMENTYSE ONLY k APPLICATION ACCEPTED BY........ _______________ DATE______- REVIEWEDBY----------------------------------------------- ---- - ------ --------------------------------------------------------------- DATE BUILDING PERMIT ISSUSED- '==------------------ ---------------------------------•------------�------- ------ DATE---------------= Alterations and/or recommendations:--`- =--------------------------------- ------------------------------------------•---------••------------------------------•--------- ------ ------------------- --------------------•----------------------- ------- -- ------------------ ' J:G �� -- � ----� ��----------------- ------------------------------------ ---- ---------------------- -- -- ----- -- --- " ' 3 ' FINAL INSPECTION BY - ---- ------ - ---•--�� ----------- Date-------------671--v/l C�- 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 _ES-9r--2M Revised 9-'59 F.P.Mt^ _w- � v..