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APPLICATION FOR SANITATION PERMIT Permit No. _.1. 1. . _- (Complete in Duplicate) Date Issued ________�,2/ -a - This This Permit Expires 1 Year From Date Issued __.:___ Application is hbreby 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. ZC3e- JOB ADDRESS AND LOCATION---C-0- -- y_ _.. I hP_. C/J�SLa vE �` `J �'� ---------------- Owner's Name__ -r --.. (I - / ll.r'�`t� Phone A J� � 3 Address -------•--------- -------- ------ -- Contractor ' •-- ----- -- -�� % Phone...- Contractor's Name____ __..___ ��r�n:. _ _ Installation will serve: Residence ❑ Apartmen#- House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other `� I Number of living units: ------ Number of bedrooms .-- Number of baths Lot size ____ __ ®.__-_____.__.._____________ Water Supply: Public system ❑ Community system ❑ private Depth to Water Table --------- ft. ..Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NcV New Construction: Ye No ❑ PHA/VA:Yes El No El TYPE OF INSTALLATION AND SPECT CATIONS:- _2l! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .f /J Septic Tank: Distance from nearest ---Distance from foundation----- 0-------Material_4 ---------------------------------------- . No. of compartments-,oZ-------- ---- .Size. _ ---Liquid dep�h---' -----------Capacity- Z-Qom------ Disposal Field: Distance from nearest well _..._Distance from foundation-_ -- - I- -------Distance to nearest lot line--- Length of each line__ P-�__.S°�_rrO�.Width of trench '--_______________ Number of lines_ "• Type of filter material s_ "` -_Depth of filter material_-1 -----------Total length------- ,,'1-Q_'-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-__-.-_-_.-.._.. d ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- [] Size: Diameter--------------------------------------Depth.----------=N: Liquid Capacity gals. Privy: Distance from nearest well-----------------------------------------r--_----Distance from nearest building------------------------------------------_---. ❑ Distance to nearest lot line--------------------------- -------------------------------------------------------------------------- --------------------- ~ - - -. . . --Remodeling and/or repairing (describe):------_4---� 4 - - - } - � — ----A---------------------------------------------------------- -----------"--'-----r-i--1-`-p--'--r-- -------------------------------------------- --= - --- ----- i 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 regulation f the San Joaquin Local Health District. (Signed)__A'Z''�WSJ '�- -+�-Q- - -Q -f /1 `r ---- � '�'c C Contractor) ^ I / - f ----(Title)-------------------- (Plot plan, showing size of lot, location of system in relation wells, buildings, c., can be placed on reverse side). FOR DNT US ONLY APPLICATION ACCEPTED BY------ --- --------- - TE------ r a------------------- REVIEWEDBY-------------------------------- -----------------------------------------------------------------------------=-------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE---------------------------------------•----- --------------- Alterationsand/or recommendations:--------------------------------------------------------•----------------------------------------------------------------------------------------------------- ------------------- -------------------------------------•---•-------- ----- ----------------------------------------------------------------------------------.--------------------------------------------•--------------- } ------------------- -------- ------------------------------------ -------------------------------------------------------------------------- ---------------•---------------------------------------------------------------- -- --------------------------------- ep ::V m. . FINAL 'INSPECTION BY:. -------- --t-- --- ---- ---------- Date------- _.. �� SAN JOAQUIN LOCAL HEALTH DISTRICT 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 P.P.Co.