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'�gJ1O ° % APPLICATION FOR SANITATION PERMIT Permit No. _.1 .. . G "v !t (Complete in Duplicate) 72 Issued /�"!. 6 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 instaU the work herein described. This application is made in compliance withCountyOrdinance No. 549. JOB ADDRESS AND LOC,6TION........./y � (. ----—_ Owner's Name------- f-Cil --•--•-- 15;,27-1 ---•-•--••---- ------ Phone-----------------------••---------- Address .. `_J49-�)d------------------------------_--------- ---..------ ... '" -----•----- Contractor's Name_---.-.....� l:r to---- "*.. i�' � ------''�- '-----------•-------- Phone �Ive ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ ____ Number of bedrooms 2-- - Number of baths _1___ Lot size ____-.�*--llfv__--- --------------------- Water Supply: Public system Community system ElPrivate El Depth to Water TableC'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptiieil: Distance from nearest well-----------------Distance from foundation--------------------Material_____________.._____._____----.-_-_.________._. No. of compartments-------------------------- depth-------------- ---------Capacity--_--------��_- (g Disp s gField- a Distance from nearest well-_�.AMrrDistance from foundation--/L?----------- to nearest lot lire--40- { (� ( ► Number of lines-------/-------;�__`. _Length of each line____._(9_-_`�_____._.Width of trench.__ ____________________ 'J Type of filter material._--_ Depth of filter material---- 1��---- P ��------------Total length ------------------ ----- - -� /� r i' Seepa it: Distance to nearest well----- from foundation__/49----------Distance to nearest lot line_____._ /�'� Number of pits-----f--__.___.___.__Lining material___/ L �_..5ize::Diameter__ f�..___..Depth__._ '_____________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------___----._____._:________•-_-_ Size: Diameter---------------------------------- ---------- --------------------Liquid Capacity-.----------------------- 9 ❑ __ Depth-------------------- __gals. Privy: Distance from nearest well ______-------__---------------------------------Distance from nearest building.-f--- ---_----_____________.__._____._. ❑ Distance to nearest lot line---------------------------------------------------------------• ------------- - r f' --. Remodeling and/or repairing [describe: �.. .--� '� * "�'�------ ------------------ --------- ------------ ---- - -------------------- �i------------ � ----------- ---------------------------------------- � �` .z ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that 1 have prepar application and that the work will be done in accordance with San Joaquin County ordinances, State layrs) and rules an regulat' ns of the San Joaquin Local Health District. Q ---- -- ---(Signed) (Owner and/or Contractor) or) By:------------------------------------------------------------------ '� --------- ------[Title)----- ---- (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, et can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ------------------------- DATE ✓�1- ---- REVIEWED BY -- - - ------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alteafigmsand/or recommendations: - • - -------------------------------------------------------- ---------- ------------------•-------------- ---`- ----- -- ---- -- ------------=------------------------------•-------------------- ----------------- --- ------------------------------ -----------------------------------------------------------------------•------------------ --------------------------------------------I--------------------------------------------- FINAL INSPECTION BY: ------------- --- -- ---- -- ---- -- ------------- - Date- -------- - - ---- - -- -- Q------------ ------------------------------ SAN - - - -------------------- 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-9-2M Revised 8-'59 F.P.Co.