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5 APPLICATION FOR SANITATION PERMIT Permit No. ...�f _..� (Complete in Duplicate) i Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to.the San Joaquin .Local Health District for a permit to cons Litt n i' nstall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND-LOCATION------------------- ---- 1-------eL Q ------------------------------------- 1.-� --------------------------------- Owner's Name---------- Q --5----------O --...- =-yi-al ----- 04-R•to------ -------- ----------------------------------------- Address------------_-- Q 9 .IA. _ _lL`_!_f_ •------------------------------------------------------------- Contractor's Name---------------------?+ Phone... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [:] Other ❑ Number of living units: __ L Number of bedrooms _2/ Number of baths -!___ Lot size .--------------- �_�-�-�'---Cr--------- Water Supply: Public system E] Community system E] Private Depth to Water Table_._____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-ElSandy Loam ❑ Clay Loam [I Clay ❑ Adobe �rdpan C] Previous Application Made: Yes ❑ No New Constructioin: Yes M<o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted if public sewer is available.within 200 feet.) —}— Vj Septic Ta k: Distance from nearest well ______________Distance from foundalion--1-1 '_.Material___.f _ �'l-� -----�-'_.Q.�__Ir.. �/ f OfJ 1- No. of compartments----- --- ---- - -- --I-(- ---Liquid depth----.--- -_. Capacity--- ----:-- :-- Size_-._ ��jj r Disposal Field: Distance from nearest well____-__.--------Distance from foundation..10'4 !_ _.Distance to nearest lot line._-.. 111` Number of lines---------- --------_ Length of each line# 11 `7'�_'�.Width of trench------ Type of filter material___ �__ �C _Depth of filter material___` _____________Total length_______._1_,�_ --_-._________._ 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-------------------------------------- " ❑ Size: Diameter--1---------------- ----------Depth------------------------------------- ------------Liquid Capacity----------------- ----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------- Distanceto nearest lot line--------- --------------------------------------------------------- --------------I- --- ------------------------•----------------- Remodeling and/or repairing (describe):-- '";-=------------------- -------------•------------------------------------------------------------------- -_--------------------------------------------------- ------------------------------------------------------------------------------------- --------------= = ,:-------------------------------------------------- -----------------------------------------------------------•-•---_------------_ =---------------- . -- ---------- --------------------------------------------...- I hereby certify that I have prepared ibis application and that thelwork will be,done in accordance with San Joaquin County ordinances, St to laws, and rules and regulations of the San Joaquin Local Health District. - - (signed) !�'' ' ------------------------------------------------ ---------------=---------(Owner and/or Contractor) 4 By:-----------------------------------------------•----------- `.- -------------------------j_------------------------------------(Title)---------- ----------------------------- ---- - - --- --- (Plot plan, showing size of lot, locationof system in relation-to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY-i. APPLICATION ACCEPTED BY----------------------- ------ t � ------ ----- DATE------------ � 0------------ REVIEWEDBY-------------------------------- ------- DATE----------- ------------------------------------------------ BUILDING --- ----- --- --- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------------------------------------ DATE------------------------- ------------------ --------------- Alterations and/or ecommendations:__ ___-_..___ ------------+------- .- f '--- * _..-_-. ...----- e -- - -------- - - --------- s ----------------------------1--•---------- -•---------- - ------------------------- --- - -- -- ��--------------------------.. _.__---- - x------ --- -- ---------------------------------- --------------- ------------------------------- _-_ -------- FINALLINSPECTION BY------- ----------------------------------------•---------------- Date--------------------- --------- ------------------------------------------------ G>d SAN JOAQUIN LOCAL L HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised 6-'59 F.P.Co.