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APPLICATION FOR SANITATION PERMIT Permit No.11 (Complete in Duplicate) Date Issued -__,�v �� ---- 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. A//1-)1 1 r 7 JOB ADDRESS ANaCTION-611- - - ' -- Owner's Name--------- ------ --' Phone------------------------------------ ---------------- Address-------------•-•----- ......-------- ---- --------------------- -------•--------------- / Contractor's Name------------------•"-.--• --------.------ Ph !� ��.r/,� Phone-A. _ ----�--['��'-�- Installation will serve: Residence [B- Apartment House ❑ Commercial ❑ Trailer Court ❑ -7M Motel ❑ Other ❑ Number of living units: __I-- Number of bedrooms _3._ Number of baths ___�__ Lot size --v`��---- Zo Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table 4/ f. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe --Hardpan ❑ Previous Application Made: Yes ❑ No Pi"'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.) is k:. Distance from nearest well________________Distance from foundation___________________Material------------------------------------------------ z No. of compartments------ -------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Q Di sal Id. Distance from nearest well------ ----------,Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines---- '""--- ---"-----------Length of each line-----------------------------Width of trench---------------------------- ------.. Type of filter material------ of filter material-------------------_._Total length_________________________________________ ."�_ Distanc m f nclation___.� "__--__.Dista ce to nearest lot line"_4-7/--_ Seepage Distance to nearest well-/_ _�� l-7 Number*of pits.-..-/------------Lining material-__ "- --Size: Diameter----_31".--- ----Depth--vZ-,�---1------------------ Cesspool: Distance from nearest well-----------------Distance from foundation.-. ---------------Lining material------------------------------------- gals., Size: Diameter---------------------- = iDepth----------------------------------------------------Liquid Capacity--------------------- _...,r.... .. _,. Privy: Distance from nearest well________________________�------------- ---Distance-from nearest bui ing---------------------------------------- Distance to nearest lot line---------------------------- Remodeling and/or repairing [describe]:___ .'r''--- ---- -•----------------------------------- ----------------_------- -------- ----------- ---------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a: ordinances, State s, d rules and regulations of the San Joaquin Local Health District. (Signed) - ---- ------ -------------- ----------jOwner and/or Contractor] BY --- -------------(Title) I-------- --- ------- ----- ------- --------- 9 p (Plot plan, showing size of lot, location of system in relation 199 ells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY DATE----- - . APPLICATION ACCEPTED BY---------------- --- --- - - --------------- ------ ------------------------------------------- t -------- REVIEWED BY DATE 7 Ili BUILDING PERMIT ISSUED DATE Alterations and/or recommendations---------------------- ------•------ •----------------------------------------•-------------- ------------ ----------------------------------------------- --------------------------------------------••----------- r ---------------------------- ------------ FINAL INSPECTION BY.-------------- --•--------- - --=-- -------------- Date--------- - ------------------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT �r 130 South'American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. - �v.