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n A 1 L./ 0 APPLICATION FOR SANITATION PERMIT Permit No. ._fl.__[�._��',�7. 4 (Complete in Duplicate) Date Issued ._ �I� :�- 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 Ord' n No. 549 JOB ADDRESS AND L CATION--------Z at Owner's Name �' - / G ._.@ .y - -----• ------� --------� � t/��lHfl�ne Address 1111 p�4`.. -•-••--•---- -------------------------------------------- ---------- Address ---------- Contractor's Name------- �- ._. x----- ---------------- Phone----------------------------------- i Installation will serve: Residence a Apartment House ❑ Commercial ❑ ;Trailer 'Court ❑ Motel Other ❑ . � � . ._ Number of living units: -_ -- Number of bedrooms-- Number of bath„�__� s ._ Lot size ---------- ______________________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3f Hardpan ❑ Previous Application Made: Yes ❑ No & New Construction: Yes ❑ No A_ FHA/VA: Yes ❑ No Pk TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S epM T a r6k.-I Distance from nearest well-----------------Distance from foundation--------------------Material------------------____-__-___________.__________- No. of compartments---------- V_ _�041)isfance �Size1111------------------------Liquid depth--------------------------Capacity----- ----------- --- Dis os.al Fi Id_ Distance from nearest well_ from foundation__.._. + -------Distance to nearest lot line_-o ------- Number of lines-_...____ae_X_�t 11 Length of each line------- __-____.Width of trench ___ De th of filter material________��--______Total length--_-.__-I/ __T________----____Type of filter materiap Seepage Pit: Distance to nearest well------ ---------------Distance from foundation--- Distance to nearest lot line____.__--__-___-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------- -------Depth----------------------------- r Cesspool: ; ,Distance from nearest well-----------------Distance from foundation-_4----!_""..Lining material_____________________________________. ❑ Size: Diameter--------------------------------------Depth------------------------------ --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearestwell_____________-----------------------------------Distance from nearest building----._____.______________ ❑ s Distance to nearest lot line------------------------------------------------ ---------------------- ---------------------------------------------------------------- Remodeling and/or repairing (describe):------ ---------------------------------------------------------------------•-------------------•------------=------- -------------------------------- F I k 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. (Signed) -----------------------------------(--- --------------- - and/or Contractor) B ----------------------------------------------- ---(Title)------------------- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., carr;be--placed on reverse side). FOR DEPARTMENT USE ONLY „ APPLICATION ACCEPTED BY----------A4- -- --- ------------- --------------------------------------- DATE------------- ------------------------------- REVIEWED BY--------------- ----- — - - --------- --------------------'----------------------------• ---•-------------- DATE---�------------------------------------- BUILDING PERMIT ISSUED---------------------------- ---------------!----- DATE--------`=----- .. ---------------•--•--------------•---------------- ------------------------------------------- Alterationsand/or recommendations:---S-- ------- ------------------------------------------------------------------- -----------------------1---•----------•-------•-•---------------------- " -------------- " -- l- ----------------- -----•------------------ -- -- ---------------------------------- -----------_------ ----------- . ----. ...---------------------------- -------------- - - --- -- ------------------------------------- --------•-.. ---------------------- - -------------••-•------------- FINAL INSPECTDate----------- --- ------—.6 ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ! ES-92M Revised 8-'59 F'.P.Co. ;[( ti�a