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k APPLICATION FOR SANITATION PERMIT Permit No. ...�... .3. (Complete in Duplicate) �� I This Permit Expires 1 Year From Date Issued Date Issued --- Application ssued ---Application is hereby made.to the San Joaquin Local Health District for a permit to nstruc an s all the work herein described. This application is made in compliance with County Ordinance No. 549. I, JOB ADDRESS AND LOCATIO !_ -- -------- -r___`.,�� 1_ - . ------------------------------ ------------------------ r� ----------------------- Owners Name----------- -------�-'---- ---- .-f --f� === ----�-- ---# ------------- --- - AddressCL 60Ue.— ---------------- ------------------------------------------------- Contractors Name________________ --- ----------------- ence )" Apartment House Commercial Trailer Court Motel Other Installation will serve. ' Residence � � : __.____ Number of bedrooms -- -__ ��__ Number of laths - -__._ Lot size $: /' x- Number of living unitslf � _ Water Supply: Public systelm ❑ Community system ❑ Private :K jDepth to Water Table -------- ft. Character of soil to a depthof3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ fAdobep& Hardpan ❑ Previous Application Made:'Yes No ❑ New Construction: Yes ❑ No'& FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.] l' „ r Septic T nk: +. s Distancetirom4nearest well-----------------Distance from foundation-------------- Material_.------------_--------------------------------- t No. of compartments Size r Liquid depth Capacity----------------------- Disposal ield: Distance from nearest well_________________Distance from foundation--------------------Distance tolnearest lot line_____.____--_____ XNumber��of lines________________"__"2 ___Length of each line-------------6,ra_____.Width of trench-----------;L----___________.- Type of�filter material__ _Depth of filter material---- :---._--Total length__-.1_2--Q______________________ Seepage Pit: Distance`to nearest well............. __-----Distance from foundation...:...............Distance to,nearest lot line__.__.________._- ❑ Number!'of pits------------- ------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- C> Cesspool: Distancel from nearest well-----------------Distance from foundation------------.-------Lining material____..__---.______._________-______- ❑ Size: Diameter------ ----------l---f-- -------- Depth---------------------------------- ----`-- -------Liquid Capacity----------- -------gals. Priv Distance from nearest well i----------------------- --- Distance from nearest building .__-.._. Y= g----------------------------------------- - ❑ Distance., to nearest lot line--------------------'---- --- --=--------`s:----•----------------------=------------------------ Remodeling and/or repairing (describe):----- ED':-- + h!L-----_�?_H_ _l _ D --'------ .�. r li I XI. ------ ---------------- f- �n 1 l-------�---�. ..._/..� ----- - `t j ' '------------------------------------- ----- -- - 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)------------------------------------------------------ -------------- ----- - ---------- --------------------------------------------------------------- -------(Owner and/or Contractor] By: ------------il-----------------------------------------------------------------------------------------------------(Title)------------------------ ---------------- ---.. . --- (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD ARTMENT USE ONLY i APPLICATION ACCEPTED!BY--------------------- ---- ----- ------------------------------------- DATE j '� ---------- ---- REVIEWEDBY---------------------- ------------- ------- -------------------------------------------------------------------- DATE----------------------------------- ------------------------ BUILDING PERMIT ISSUED!"---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:------- ---- ---------------------- ------------ ---------- ----------------------•--------------------------------------------------------------- u ---------------------------------------------•------------- ---------_ _._c--•---- •------------------------------ ----------- --------------------------------------------- { --------------- I�---- .P- -------------- --- - — --- ---- -----3R",- -------------<. `..r' ------------- f a -----_ ! F F5 r r FINAL INSPECTION BY:.;--------- ----------- - ------ - -- Vale it S JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street" 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California P ES-9-2m Revised 8-'59