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APPLICATION FOR SANITATION PERMIT Permit No. ...!_�-. .. .l. j6" gV (Complete in Duplicate) ?_ - o. to This Permit Expires 1 Year From Date Issued 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 Ordinanc No. 54 � JOB ADDRESS AN C TION.._ ;t-�� ---------- ----C;.4 -y -------`----- Owner's Name----------- -- Z '------------• ------------- - ---- ---- Phone-- ---------------------------------- ------------------ - ---------- Address.-.."------------- - Contractor's Name - -- Phone.. Installation will serve: Residence ❑ Apartment House Zr°tommercial [] Trailer Court ❑ Motel ❑ Other �±__ Number of bedrooms __'�____ Number of baths . -- Lot size _�.�f-��3 Numbar of living units: _ ----------(zw,�rz) Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _A//_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EK-Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes U?"No ❑ FHA/VA: Yes ❑ No P2— TYPE OF INSTALLATION_ AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: }. Distance from nearest --Distance.from foundation----0 ----.----.Material---- ----...-_ -. ---- No. of compartments--j------ .l.__Size� _KOW11f_-Liquid d`pth----�Z---------------Capacity-_,PS P------ Disposal ield: Distance from nearest well.�_�___.._ Distance from foundation-AQ s 1l+-7�~ --- �1�_____._____Distance to nearest lot line___ ___________ r Number of lines_____ - _�---- ---------Length of each line_--��--�__-_-_._______.Width of trench_.1`-0-�l-------------____._ 11�` p +Al Type of filter material __�_t_1:Q_ Depth of filter material----- _______-Total length_____fA- ____________________ Seepage Pit: Distance to nearest'well___�� __J.-_-Distanceom��,,fo``undation___ e-_�_____D'snce to nearest lot line___ .�_•Z�" -Number of pits--}' 1_________.Lining material__ _ _ Cl�! .5ize: Diameter__ ��__._--__Depth_-_- v � =------------- Cesspool: Distance from-nearest ell-__'.__=_- -Distance from foundation--------------------Lining material______________________________________ t [] Size': Diameter----------------------------- Depth--------- ------------------------ -------- --------Liquid Capacity----------------------------gals. E. Privy: Distance from nearest well---_k_ ------------------------------------------Distance from nearest building_____.____.________._________._ i ❑ Distance to nearest lot line------ -------------------------------------------------------------- ----------------------------------------------- Remodeling and/or repairing (describe): '----------- -------------------------- ------------ 1 ---------------------------•---------------------------------------------------------------------------------------------------4_4_t�� ---------------------------------------•------------------------------------ ------ } ------------------------------------------------------------------------------•---------•--------------- -------•-------------------------------------------------- -------- ---------- ------- -------------------------------------------------- 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 regyllafions of the San Joaquin Local Health District. Contractor)- - - - - {= = �. ------ By:---------------------------------------------------------------------- ------=-------------(Title)------ -------- ------------ 1 • (Plot plan; showing size of lot, location of system ' _relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---=-- = DATE -� ' —�� REVIEWEDBY------------ --------------------_ ------------------------------------------ -------------------------------------'____,DATE-----------------------------------•---------------------- BUILDINGPERMIT ISSUED----------- "---------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- ---------' f r1 i y'. w - FINAL INSPECTION BY CDate-. -------------------------- (f------------------------------------ SAN JOA UIN LOCAL HEALTH DISTRICT_ J? t p i..ti 130 South .American Street 300 Wast Oak Street. . 't ,1 r� 132 Sycamore(5e914 North "C" Street California Manteca, California, Tracy, California Stockton, California Lodi, ES-9-2M Revised 8-'59 F.P.Co.