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5i APPLICATION FOR SANITATION PERMIT Permit No...:�%_lam_. _ (Complete in Duplicate] Date Issued .____J_'�-G q" f This Permit Expires t Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a poFmit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LO TION..- r f_ / Ae- ------- PhoneOwners Name.-•----------------•-------•-------------------------------------- - ------------------------ Address----------- -------------•- -- •--- Contractor's Name �� Phone Contractor's ---------- --•---------- -------------------------- Insta7lation will serve: Res idence13<'ApjTtment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms -- Number of baths /.___Lot"size .___ __ � _____________________.__ Water Supply: Public system ❑ Community system ❑ Private ®/6epth to Water Table -!V ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes �o ❑ FHA/VA: Yes E;, --'No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool- permitted if public sewer is available within 200 feet.) Septic Tank: Distance from i•nearest well -4-P ------ Distance from foundation ---- /A0------ Mat ial____-_&--- Ir No. of compartments ______..---------- � �1�.-��-:_..Liquid depth-----�y-'�-----__ Capacity ------- Disposal -- - _Size- ------- -_---�-------• _ _ Ca acct .- . Disposal Field: Distance from nearest well__ --__-____- Distance from foundetio'n..- _` __ j 7 �it�_:______-Dis#ante to nearest jof line_ _ Number of lines_______111,21 ______-__ ______. -ength of each line__�,a--Width of trench-__r`"_�_______________ Type of filter material___ -I ��i�epth of filter material---,/ P__ -.Total length _- t4-r�------------ --�_ f E -Seepage Pit: Distance to nearest well --- /Q4v__"Distance fr m '_. fondation___ld:c_____-Distance to nearest lot line ---- .� Number of pits___ ___________ Lining materialA0 _.Size: Diameter.-&- ............ Depth__. Cesspool-. Distance fi'srnm^nearest:well_'_____________--Distance from .foundation ------------------- :Lining material ------------------------------------- ,6 El -- ---------------------------------,6❑ Size: Diameter - ---------------- Depth --------------------------------------------- Liq'u'id Capacity - --------------------------- gals. Privy: Distance from nearest well ------------- _----------------------------- _----- Distance from nearest building _---_--___________________________--_-_. ❑ Distahce to nearest lot iine----------------------------------------------------------------------- --------- ----- ---- -------------------------------------------- Remodeling and/or repairing (describe)------------ ---'ate`':` -- ------- 4- ------------------------- f __________________________________________________________________________________________________________________________________________________________F _.----________-___-________--._______----_____------------_--.--- I hereby certify that`1 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. '<-------------- --- Contractor ' (Signed) ---------------- - "----------d---`-�=-�`=-- ---------- ----�=�='"=---------- (� I 4� BY: ----------------------------------------- a-�--------------------(Title= —� (Plot plan, showing site of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR`DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -I--- -- --- -- ------- -- U -- - - - ----_ -----==------------'• -------- DATE---- - -----------��---~-� --------- --- REVIEWEDBY --------------------------------- -------- - --------------------------------------------------------------------------- ---- DATE----------------------- ------------------------------------ BUILDING PERMIT ISSUED ---------_------------- ------------------------------------------------------`- ------ - DATE------------------------------------ - - --------------------- Alterations and/or recommendations--- -------------------------=-----------------------------•------------------•-----------------•-•----------------------------------------------------------- ------•-------------------------------`-------------------------------------------------------------------------------------------------- -------------------------------------------------------- 1 FINAL INSPECTION BY:- Date_. -.c = -----�----d----------- =- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street - ; A32 Sycamore Streof '� 814 North "C" Street Stockton, California Lodi, California ' Manteca, CaliforniasTracy, California ES -9-2M Revised 8-'59 F`RLo.