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APPLICATION FOR SANITATION PERMIT Permit No. _. r..-........ r (Complete in Duplicate) ' This Permit Expires 1 Year From Date Issued bate Issued ---- Application is hereby made to the San Joaquin LocaFHealfh District for a-17/-24 per ' rto construct and install the work herein describe This application is made in compliance with C6unty Ordinance No. 549Ci c. JOB ADDRESS AND LOCATION__- tGAO ------------•-------� Owner's Name -------- 9-----•-- ---------•--. _. _-----•---- -------------• - Phone_ --- �_ �1�.3 •a"----- - - ----------------------- Address --------- ._- Contractor's Name ----------- -_� ----------------------------------- , ' �. Phone..__.-------- ----------------------- __ Installation will serve: Residence EL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel'❑ Other ❑ r.> Number of living units: __D....... Number of bedrooms 2- Number of baths --- 1---- Lot size ____.� _,_x Water Supply: Public system -D Community system ❑ Private K Depth to Wafter Table -4" ft. Character of soil to a depth of3,feet:-Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑Clay_[ Adobe 14 Hardpan ❑ Previous Application Made: Yes 0 No New Construction : Yes M No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _.� f Septic Tank:Distance from nearest well --- Q...... Distance from fogndation____�_O__"-____.Mater�aL. __ __.._•. _ ?. 91 No. of compartments ------- Size_: 3(,! ri"" Liquid depth_____ � �. i- - f ------ --- Capacity -Q------- (TI Disposal Field; Distance -from nearest wefi__4�----_ Distance from foundati n___ !D.____� _� _..Distance to nearest lot line __-� I Number of lines___:__' Len Length of each line______ _ ".____. ____-__-_ 1 ' 4 Width~of'trench Z--------------------- I Type of filter material_,__ __ 11 _ -"_--'--Depth of filter material-------��---_"""---Total length-------��:_ 16'Q"_-- _-- Seepage Pit: Distance to nearest well ---------------------- Distance from foundation _____-_:.__-_.•_"__.Distance to nearest lot line-__________-"--__,` ❑ Number of pits- --------------------- Lining material ---------- ------------- Size: Diameter -------.Depth--------- ------------- Cesspool: Distance from nearest well________________ Distance from foundation -..._____-.-_,____.Lining material _____.____._.---_____.-------------- r ❑ Size: Diameter----------------------- -------------- Depth ---------------------------------------------------- Liquid Capacity-------------------------- gals. Privy: Distance from nearest well_Distance from nearest building j ❑ Distance to nearest lot line____-_____""-____-" g ----- ------ Remodeling and/or repairing (describe):_______._-"--- ----------------------------------- ' -^tea •--------------•-.- - - ------------ - --------- ---------------------- ----------- --------------------------------------------------•---------------------------------------------•---------•----------------- I hereby certify that I have prepared this application and that the work will be dens in accordance with San Joaquin County ordinances, State laws, rules and regulations -of the San Joaquin"Local Health District. (Signed)- --------------_ XP � Owner and r BY: Contractorj\fl Y ----------------------------------------------------------- Title - -- - Plot Ian, showingsize of lot, location of system m relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY - '- =" - DATE _..� ' REVIEWED BY ------------ ----------------- BUILDING PERMIT ISSUED------ ------ - - rr-------------------------- DATE ---------- ------------------------------------------- -------------------------------------------- --------- ----------------------------------------- DAME.-------- ---------------- ------------------------ A terations and/or recommendations:______ ______________ -------- -- � /---�- �---- �--j-------------------- .'' "`'Yip' ---------- - ------------------ ---- ---- ---- --- ------ ------------------------------------ FINAL INSPECTION Date ----- `' SAN JOAQUIN LOCAL HEALTH `DISTRICT 130 South American Street__;Oak Street `� 132 300 West et Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.