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r-^ter:..__ 1•• y `U M r Y�- - �� . =" APPLICATION FOR SANITATION PERMIT Permit No. .............. . li D i C [ omplete n 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 instal4 the work herein described. l This application is made in compliance with County Ordinance No. 549. 73 S JOB ADDRESS AND'LOCATION---- �fY �R Q �� ------------------------------------------------------- �r/�.�/� ------ Phone�'.y_-_` --------- r Owner's Name_______________________ 1 Address-------- Yy. ------- ----------------•-------------•----------------------- t -------. Phone----------------------------------- Installation ---------------------- - - Contractor's Name__..___�_.-1'1�1_V_�-�.--..----- - - Installation will serve.. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/----- Number of bedrooms _�___ Number of baths -__/_-. Lot size ___�_ __ _ - -------------------------•- Water Supply: Public system [Community system [-IPrivate ❑ Depth to Water Table - ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -Clay Loam ❑ Clay ❑ Adobe (3—Hardpan ❑ Previous Application Made: Yes ❑ No &3— New Construction: Yes E--No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pp I Septic Tank: Di.istance from nearest wel#�_o.�.s�_Distance from foundation__._ ©_!..___.Material____!f�. __ ®- No. of compartments-------- --------------Size---, _lf X_7-.-----Liquid depth--------V----------------CapacitY_GVQ� Disposal Field: Distance from nearest well_XoWe A _Distance from foundation__,'Q------------Distance to nearest lot line---- ---- i [v] Number of lines----------- ---------------Lengthy of each line---------GQ�- _._._.Width of trench-------2._.,__�___.----------- Type of filter materiaL___ a- =- -------Depth of filter material-----f_ ------Total length-------- -_ a_____________________ Seepage Pit: Distance to nearest well ---------------------Distance from foundation_____________-____.Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-=---------------------Depth------------------------.-------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- Size: Diameter--------------------------------------Depth------ ------------------------------------ Liquid Capacity gals. ❑ i ""'_--_Distance from nearest building --------- � Privy: Distance from nearest well---------------- ----------------------- -------------- ------- 9 --------- ------------- - ❑ Distance to nearest lot line-- ---------------------------------------------------------------------------------•------------------------------------•-------------------- i Remodeling and/or :repairing (describe);---------------------- ---------------------------------------------- -----------------------•----------------------- ------ ------- ----------------------------------------------------------------------------I--------------------•-• -----------------------------•---------------•------------------------------------------------------ I hereby certify that l 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 Joa uin Local Health District. [Signed]--------- --------------- ------- elp -----------------------------------------------•----------- -------{Owner and/or Contractor) By:----------------------------- Tale t (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-------` �—`--------------------------------------------------------------- DATE------...9`1 6'_7 -(1-,Z�---- ----------------- REVIEWED BY-------- ----------------------------- ---------------------------------- ------------------- - DATE - BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------------------- DATE------ ------------------------------------------------------ Alterations and/or recommendations------- ------------------- ---- -------•-------------------•------------------•------------------------------------------------------- � /_� � -------- _ _ �+ __ �y 6 lD / --- ll� 7 v -- - ------------------------- -------•- ----- ------ 7l-7- - -- �D4 FINALINSPECTION BY------- --------- - ----- - - -- -------- - Dafie_- ----- ----------- ------------------ ------------------------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh 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.