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Permit No. APPLICATION FOR SANITATION PERMIT ...,(. -. .��.� (Complete in Duplicate) Date Issued _3- 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 N . 549. JOB ADDRESS AND L A N------mss ✓ ------- �f ------- Owner's Name-------------- -•-------------------------------•----- r ----- ------ ._ Phone------------------------ ---------- Address - � y =---- ------- --------------------f -- ------------------------------------------------------=----.... Contractor's Name------------------------------- -• -------------------/r � �/-------------------_>-------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . Number of bedrooms f'yNui�nber of bathA��___ Lot size `9� Water Supply: Public system E] Community system ❑ Private Depth to Water Table &Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9KHardpan ❑ Previous Application Made: Yes ❑ No 19"- New Construction: Yes A"'No ❑ FHA/VA: Yes ❑ No Z' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puubblli�csewer is available within 200 feet.) Septic Tank: Distance from nearest wel -�s-�l_----_Dis#ante//from aun ation_--_/P__-----.Material---&-e,t ........... l [] No. of compartments--__ ------------------Size- Liquid depth- ` Capacity` , -__---_ Disposa Field: Distance from nearest well-��'.--_.-Distance from foundatipn-J. _--.Distance to nearest lot lin__-$e_f_---. [ Number of lines------ ---- - -----..---_Length of each line-40 ---------- Width of trench-- Type of filter mate Depth of filter material--- D. -..Total length ,f{ E�:---_---___--------.- Seepage Pit: Distance to nearest well.--/,00_....-_-Distance fr Mn foundation_--,�49_r_-_-_Dis nce to:nearest lot [in e--.�~.-�_-_ r t Number of pits--.__ __-_-- Lining material-__) ___Size: Diameter_ ��-------Depth---420.01-------------- (,a} Cesspool: Distance from nearest well-------------_-_Distance from foundation--------------------Lining ma.terial_--.---..-----.______----.--.----- [] Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. k Privy: Distance from nearest well -----------------------------------------.--_-Distance from nearest building___--------------------------------- -----. ❑ Distance to nearest lot line---------------------------------------- ---------------------- ----- r = -1. Remodeling and/or repairing (describe): / r'� - -- --- ----------------------------------------------------- _4 --------------------------------------------------------=---------------------------------------------------------------------------------------------= -- ------------------ ------------------------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and rulations of the.San Joaquin Local Health District. (Signed)---------------------------------- ---- - --- ------------- ------------------------------------ --------( /or Contractor) By:---------------------------- ------------------------- ------------------------------------(Title)--- °�;1-- -------- '. (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l`'`am - w -W---- DATE-- - � ,.i REVIEWED BY------ ------------------------------ IBUILDING PERMIT ISSUED-------------------------------------------------------------—---------------------- ------: DATE------------------------------------------------------------ ' Alterations and/orrecommendations:-----_- ------- - _-- a--- -. - --a..--_ •-----"`•----"T'"'-'--------------- ---- _-----..._-..------.---_- ------------------------------------------------------------.--------__-___._.-------------___-----------_------------------------------------------------ ..---_- -------------------- - - -----------------------------------------------------•--•-------,------------------------------.-----------'--------------------- , FINALINSPECTION BY_!-----...... -- ---- -- ------- ----- Date----------------- ------------ --- -- ------------------------ SAN ----- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street �, s 300 Was+`Qak_$treot'� - 132 Syiiamorew$tree# ",, 814 North "C" Street F Stockton, California Lodi, California "`Manteca, California Tracy, California I ES-9-2M Revised 0-'59 F.P.Co. 8