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M APPLICATION FOR SANITATION PERMIT Permit No. ._ ..�.. _ . t . (Complete in Duplicate)r"'— ._--�Da Issued ._1�-_.1�- This Permit Expires'1 Year From Date Issued - Application is hereby made to the Sanboaquin Local Health District for a permit to construct and install the'work herein described. This application is made in c&npliance with County Ordinance No. 549. } I . JOB ADDRESS AND LOCATION----- -� 7 ------ . ------ - --_----------- `-•----------------------•---------..- Owner's Name___, P)- ------- - = ---------------------- - - -------•--------------------------------- Phone- Address hone- l !F'�_ 7 ------- -------------------------•-------------•--------•-----•--•---------•-------------- i------------------ I— A Address-----------/-• --- - - 7 • -------..-.. Contractor's Name----- -------- Ate* '--------------------------•-------------------------------------------------•------ Phone h.. -, 'll Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑l e Number of living units: --- -_ Number of bedrooms -3.. Number of baths -1_-. Lot size __��_��•.--�ff--Q�/ il�! # Water Supply: Public system ElCommunity system ElPrixate [$ Depth to Water Table �',Gt- ft. r, Character of soil to a depth 11 f 3 feet: Sand ❑--••Gravel-'❑`—S 39-14---Loam ❑ Clay Loam ❑ Clay ❑ Adobe 50 Hardpan ❑ Previous Application Made: ilres 50 No ElNew Constructi n: Yes)0 -No ❑ FHA/VA: Yes RI No El s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ce'spool permitted if public sewer is available within 200 feet.) Septic Tank: Distance' nearest well_s,5T-------Distance from foundation--_ -.-Material-_._-_f IF ea� --------------------------ee i nt No. of compartmes-___��.._,____-_---�---Size__._...:��'X�--Liquid depth--.--�-i _ _____ ______-Capacity__-�0�_ Disposal Field: Distance)from nearest well--...-.._.Distance from foundation--SQ_-------.Distance to nearest lot line_&--_-------- Number o _---Number .of lines----- ------------------------Length of each line--tea- _--_--.Width of trench-------2 f!-`-..------_-__-- O } Type of filter material).-�-6t------Depth-of filter material---- ------------Total length----:-.. SQ_.�__________-.�---- a+�Q 1 Seepage Pit: Distance to nearestweli---'-�-_y----_Distance f foundation--- ce to nearest lot line_..__-... Number,of pits____ — material-----�� '--Size: Diameter___. ----__--Depth________ _____________________ n Cesspool: Distance1�from nearest w6ll--__-_----------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--" � �- - -------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nea3est well-----------------------------------------------_Distance from nearest building------------------------------------------- Distance.to nearest.!at Ilne----- ------- --------------------- ---=-----•-----------•------------------------------- ------------------------ ' ❑ '•r i E Remodeling and/or repairing (describe)---------' ---------------------^------------•----------- -------------- --------. .--------------------------------------------'------------------------- ------------------------------------------------------------------- ------ ------------ -----------------#--------- ----- --------------------------------f---------------------- ------------------------ - ---------------------•--•------------ ' ---------------------- I hereby certify that I heave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Is ndlrules and regulations of the San Joaquin Lcal Health District. u I 4- (SignSi ed) i---__."��----_ _ .______-..- (Owner and/or Contractor] { ------------- -- 9 ------ , -----------------rl ��-• ----------- ------------------------- Title (Plot plan, showing size of IiJ , locationf of system in relation to we Is, buildings, etc., can be' placed on reverse side). �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '. --------- - f-------- ------------------- -------------------------- REVIEWED DATE J Y REVIEWEDBY---------------------- --------- ------ ------ �� '�� k 1 ---------------- ... DATE-------- --- ------------- BUILDING PERMIT ISSUED---_------- -------•----i--- �� - - DATE �l i I Alterations and/or recomm jllndations:.:-- ------------ -=-- ---------- --------- ---------------------- ---------------- ----- ill--------------------- ----------------------------------------------------------------------------- ---------------- -------------------- •------------------------ - ---------------------- ---------- ------------------------•-•--------------- ---••--••------------------------------• ----------- 1 ------------------------ -------------------------- ----------------------------- ---- - FINALINSPECTION BJ�-------- `----G -------------------- --------------- Date--- ,1 - ---- - ----- -------- ----------------------------- k( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California i Lodi, California Manteca, California Tracy, California I ES-9-2M Revised 8.'59 F.P.Coi