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LICATION FOR SANITATION PERMIT Permit No. {Complete in puplicate} �,�� -� Date Issued `+ This Permit Expires I 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 No. 549. ---------------------------------- Owner's ../: JOB ADDRESS AND LOCATION J ../ ? '------•----------------------------•- --------------------------�— Owner's Name------- =p. 1__ _ `-------------- .a�'.I '�• d----------------- ---------------------------------------- Phone------------------------------------ Address---------------_-------- -------_` ---------•----- Address---------------_-------Y ` _ 4 P-R-Z`� � ?. s .r , Contractor's Name------ 7 __�. .'Q------- fv -Y_ � 8 Phone-.. /_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail r Court Motel p Other ❑ Number of living units: _)(____ Number of bedrooms __,�___ Number of baths _i__-_ Lot size -.___J ____1_ _______ ------------ Water Supply: Public system V Community system ❑ Private ❑ Depth to Water Tablej ft. Character of soil to a.•depth of 3 feet: Sand ❑ Gravel El San 4y Loam Clay Loam] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Nog New Construction: Yes ❑ NoFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic +ank.or cesspool permitted if public sewer is available within 200 feet.) 1 1 a Septic Tank: :D tante from nearest weli----�Distance from,foundation__Jd__ ___-Mate,riai______ . ` 1 No. of compartments`'---.-_Z.-----------'Size_..--Iti9-- C- _-- Liquid depth--------4---------------Capacity--. r-��t' Disposal Field: Distance from nearest we'll----____________Distance from foundation __...-=.D.istance to nearest lot lin ....... Number'of lines------------I-..__`__.._________Length of each line________` -r____._.Width of trench_.------- = -�f_-______ Type of filter material. ._. � `_ --Depth of filter material____._ _ '_ _Total length___.___.�-�_a -----------, ---- Seepage Pit: Distance tojnearest well_ _______ _ _ ___ __Distance from.fou dation___-_f Q_r._.Distance to nearest lot line----- Number of pits:______-_---_--Lining material___ � __4 -Size: Diameter__._ _�.�J____ Depth_._��- 4 Cesspool: Distance-frorfn nearest well-----------------Distance'from foundation---------------------Lining material-_-_...__________._.____.____-___.___. ❑ Size: DiametX---------- ------------------------Depth--------------------------------------- b, ---------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------_----------Distance from nearest building_--_..._____._________------------------ ❑ Distance_to nearest lot line--------- ---------------------------------------------------------------------------- Remodeling --------------------------------------------Remodeling and/or repairing,(describeF--" `_-___-.---- �__________________________________ ------------------------------------------------------:--------------------•----------------------------------------- ----------- •---------------------------- ------------------------------------------------------------------------------------------- ----------------------------------------------- ----------•----------------------------------- ----------------------------------------------------- ----------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---__---- _ ? --- 5__ ]-------------- s_ ----------------------------------------.(Owner and/or Contractor) ~ /�7 J-' / bY� �'-"` ^ r------ ----------------(Ti+le)------------------- - (Plot plan, showing siz6of lot, location of systemrelation to wells, buildings, etc., can be placed on reverse side). R D RTMETITUSE ONLY rr i APPLICATION ACCEPTED ;B - ----- DATE__..------REVIEWED BY----------------------- --- ------- •--------------------------- -------- --------------------------•----- DATE.--.---------------BUILDING PERMIT ISSUED._ -------------------------- ----------- DATE-----AlteratidteI --- n — �? , -------- --------------------------------------------------------------------•-------------------------------------------- e=-------------- I------------ i. Date------------ (P �.�_ . FINAL INSPECTION BY: 1� ,-�J � — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak'Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Fi Manteca, California Tracy, California r ES-9-2M Revised B-'59 F.P.Co. 1