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f d U APPLICATION FOR SANITATION PERMIT Permit No. ----�C w '= (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 to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, 11711 JOB ADDRESS AND LOCATION------40-T_-4--l.......0.2 G_ 4_4.V_d 1- 5 " - -- yam_ Owner's Name--- ------------ ---------------------------------- - -. Phone-------------- -$.2��y---- Address---- `b ' - ,r Contractor's Namelt� fi� `------ ------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __i/___ Number of bedrooms _�?___ Number o) baths _l___ Lot size ___- .S_�_—�_-L3- _______ ____-_--.___ Water Supply: Public system Eli—Community system ❑ Private ❑ /..'Depth to Water Table 51-0-___ ft. t Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy /,am E] Clay Loam E] Clay El Adobe 0--Hardpan ❑ Previous Application Made: Yes E] No E New Construction: Yes`a"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND iSPEC IFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance frominearest well_,&_Q_4/,0_Distance from foundation-----LO_r..-_-_.Material___lY� No. of compartments-----------:1------------Size--- -X- ------q------Liquid depth------ ---------------Capacity____SIPt7 Disposal Field: Distance from nearest well._/[1a1ll Distance from foundation____-IjR`___--.Distance to nearest,lot line--__S'___.. `n EKY Number of lines.__________-y__________________Length of each line-__----_Va_---_______-Width of trench--_-__-?_�,_-_______________ ti Type of filter material-----lf_GCt-f--------Depth of filter material___- Total length_____ _______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- Size: Diameter-----------------------Depth----- --------------- ❑ Number of pits----------------------Lining material------.=--------_--_-- ---------- ; ry ------ Lining material---------=--------------------------- Cesspool: Distance from nearest wel!_______ ________Distance from' ❑ Size: Diameter--------------------------------------Depth---------------------- ----------------------=------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-____-_______--_--_-_-____-___--__-_. ❑ Distance to nearest lot line---------------------------------- -------- a Remodeling and/or repairing (describe):------ ----------------------------------------------------------------------------------- ------•---------------------------------------------- -- --------------------------------------------------------------------------------------------•-•--------------------------------------------------------------------------------------•-------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------`-------------- ------------ 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) 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__=_--a ` ---- ----------------------------------------------- --------- DATE------- REVIEWEDBY----------------------------------------------------------------- ------------------------------- -- ---------------------• DATE------------------------------------- BUILDING PERMIT ISSUED-------------- ------------------------------------------------------------------------------------ DATE ------------------------------ Alterations and/or recommendations:------------------- -------------------------------•---------------------------------------•--•--------•----- ' i --•- - s T --------------- ----------------------------------------- ---- ' -------- ------------------------------- ` --------- ----------------------- --------------------- __ ____________________ � ^ _ ______ _ -------- --- _____A � �7 _______ ---------------______---_-___ __- FINAL INSPECTION BY----------------- ---- --- -------------- -- Date---- -- --------------- - - -------------- ---------------- - � ---------------------- ••- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS41-2an Revised 8-'59 F.P.Co.