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APPLICATION FOR SANITATION PERMU Permit No.vs .fl:�-1--�•- 1!� t (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued . Application is hereby made to the San Joaquin Local Health-District.for_a permit Q'c 3tf ct nd stall the work herein described. This application is made in compliance with County Ordinance No. 549.10 JOB ADDRESS AN CATION.___ .� ---------(.� ={6 Phone Owners Name----- � --- . kfC�'_t -------- ------------------------- -------------------- 1700 511 --- - r , Address------- ��3-------- -1-•-----' r � `p '-------------------'-----------------••--•-----------------------....---------=-------------•--••--•-------•----•--------------••---- t l Contractor's Name----------------��L.�-A -y. '-------------------------- -- ----------------._..-----------------•------ Phone.-------.....---------------------- Installation will serve:; Residence $L Apartment House ❑I Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number'of living units: _�__ Number of bedrooms&____ Number of baths __/___ Lot size __/ _ _�____-.�- ------------•--------------- Water Supply: Public system Q Community_system ❑ Private ❑ Depth to Water Table _-_dr._ ff. Character of soil to a depth of 3 fee Sand E] Gravel F] Sandy Loam❑ Clay Loam E] Clay ❑ Adobe Hardpan C] Previous Application Made: Yes El .i No FML New Construction: Yes K No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: •(No•septic-tank,;;or cesspool permitted if pl' sewer is available within 200 feet.) Septic Tank: Qistance fifrom nearest well/4%9_Distance from foundation----- d______-_.Ma �ial______ ---Li uid'de th---- _-_. -----Capacity-- PAC a acit ------ No. of compartments---------- _Size�_ �-� q p. - --- � p Y-- r ` +�________D•istance to nearest lot lirpe---�-_. Disposal Field: Distance from.-,nearest we _ 'S.istance from foundation__ -. [� Number of,lines---------------- ---------- Lengfh of each line--------- _- Width of trend y___-sa ------ ---�"--------�� Type of filter material__ _ . - ___Depth of filter material------�__-____Total length--_--- ___=------ b1 Seepage Pit: 41l Distance to nearest well----------------------Distance from foundation__ ----------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material----------------____---Size: Diameter____________-____-__.Depth___1�1__-.________ ______------- Cesspool: Distance from nearest well t Distance from foundation_.'_------_-______.Lining material-_-____________"._________________ ❑ Size: Diameter, a: _ . ---- ---------" Depth----------------------------------------------------Liquid Capacity- ------------------:---=--gals.. Privy: Distance from nearest well-_______----------------------------------------Distance from nearest building--------_____________--_--------------.-. ❑ Distance to nearest lot line------------------- -----------*--------•----------------------------------------------•--------------------- 4 Remodelinand/or repairing (describe).----------�'--�`----------- ------------- -----------�-----------------------------•-----------------------;-=-------•--------- ... y ----------•-------------------------------------------------------------------------'•--------------------------------------------------------------------------------- -------------•-------- ---------------------------•----------------------•--------------------------------------------------------------------------------- --- - ---- --------------------------- --------•----=--•----------------•---------------'-----------•--•-----------------------------------------•----------------------------•----------------------- 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. c ¢ -__- wrier and/or Contra ) (Signed)-=-'-�=------�- -+�- - ----------- ------ C� ------- - - ----� - - --- "------------------- ------------------------ --- -------------------------------=------------------ -------- Title ---- ----------- By:---------------------------------------------- { )---------------- -- (Plot plan, showing size of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). ,'FOR DEPARTMENT US'E-ONLY APPLICATION ACCEPTED BYE _ .�- `--------- ---- -------- DATE------------- -------------------------------- --------- r I f - k DAT'E------�.�'_--------------------------1" REVIEWEDBY----------- --------•------ - ------------•---- --- -� - =- ------------ --------------------------- ----------------------- t.", •------------- ---- BUILDING PERMIT ISSUED------------------- ------------r --�'-`'--------------- ----------- DATE. 5. Alterations and/or recommendations--------------------- ------"-'�-----�-------------------------•----------•------------•------•-------------------------------------- ---------------- ' .: ..,. -- ------------------------------------------------------------------ e 1 ---- ------------------------------------ ------ - -------- FINAL INSPECTION BY--------------- Date - ` ��, r 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 8.'59 F.P.Co. .- f