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' APPLICATION FOR SANITATION PERMIT Permit No, ------- (Complete in Duplicate) Date Issued a__r_I-$ -6,C) This Permit Expires 1 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. Qf j- i JOB ADDRESS AND LOCATION ------------- ---1___---j--_�------------�e-`------- --��'--�1mLi�-��-�'------------•-------------------- ----------•------------ Owner's Names-- Phone Address-------------------•----___------- --11_...--•-N-p-{---.Q_011 at 41 P., ---------------------------------------------------------- -------------------•---------------------•-•---- Contractor's Name --------------------------------- -----•------------------------------------------------------------------ Phone ----------------- ----------------- Installation will serve: Residence V' Apartment House ❑ - Commercial ,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---- Number of bedrooms"_,3- Number of baths _-/____ Lot size ------------------------------------------ ----------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Wafter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2/'Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes Pff""No ❑ FHA/VA: Yes ❑ No 0�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet. r Septic k: Distance from nearest well_ 6-99------ Distant fro foundation__- ----------- - -----_.Material---`�. q No. of compartments_-_-_---P-•----------Size---�x_---{_---Liquid depth ------------------- Capacity---_ -- Disposal Field: Distance from nearest w II -__.Distance from foundation___ -__,}a._ -_-Distance to nearest lot I'sn �__�_______ ,�,/ Number of lines______________ _ Length of each line ------- .ea------ Width of trench_._._ ___9________.y -------- T ------_ Type of filter material____.to Depth of filter material ____._____.__.__ Total length _________r______________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ----------- -------- Distance to nearest lot line -____-_-____----- O 1 ❑ Number of pits- --------------------- Lining material -_s ------ ------------- Size: Diameter ----------------------- Depth --- ----_- --------------------" p � Cesspool: Distance from nearest well ----------------- from foundation ___-_.-___---------.Lining material _______________-__-------------_____ ❑ Size: Diameter----- ---------- -------------------- Depth -------------- -------------- ---------------------- Liquid Capacity----------------------------- gals. ______-________-_--_Distance from nearest building_---- ------------- Privy: Distance from nearest well__________________________ _ � ----------------- ❑ Distance to nearest lot line ------------------------------------------------------------------------------------------------------------------ -------------------------- Remodeling and/or repairing (describe): --------- T__V sS`_ Iafil--------'P.�-----160'&-�----•--�'�----------------------- `---------------SShaw--K------- 0--w-----��.---------------------------------------------•------------------------------ - ------------------------------------------------------------- -------------- =-------------------------------------------------------------------------------------------------------------------- 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. - -----------------------(Owner and/or Contractor) I {Signed)------- ----------------------- = ------ --------- By: --------------------------------------- ----------------------------------------------- By:------------------------------------------------------------------------------- --- - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------- ------------ -- -----C-- ----------------------------------- DATE 4 REVIEWEDBY —`----------- ------------------- DATE- --------------------------------------------------------- BUILDING PERMIT ISSUED--------------------________-_-- DATE ----------- �- ------------------- Alterations and/or rata a dations:`- ------------ .o• /�/� ---------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------- ------------------------------- - - : - --- ------------------- ---------------------- FINAL INSPECTION BY: � F --.f --------------------- Date a -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRrT 130 South American Street 300 West Oak Street 132 .Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 6-'59 F,P.Co.