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z— APPLICATION FOR SANITATION PERMIT Permit No. .__.!................... (Complete in Duplicate) Date Issued ___ This Permit Expires 1 Year From Date Issued Application is hereby made to the San tJoaquin Local Heal}h District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__-.-f----irk A-�F----- k- --- -�-9-440)&_4----------------- �brfi�r--------------- Owner's Name...... --•--- ----••---------- ----------------------------------------------------------- Phone-----------------------•------------ Address------------- 1` X!'t .r------------------•-------------.....-•-------------------------------------------------•----------------------...------- - Contractor's Name__'______ Phone. "_ � � Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms X- Number of baths --L___ Lot size ___11,02_. ----------------------- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table _ _b ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application.Made: Yes ❑ NoV New Construction: Yes ❑ No FI-IA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pt' �nk: Distance from nearest well_________________Distance from foundation--------------------Material _._-____._.___.__.-_-__----___-___.______.___-_. No. of compartments----- - -------------- ---Size--------------------------------Liquid ddepfh--------------------------Capacity-------------- -r Disp i field: Distance. from nearest well..�>�_�---Distance from foundation___—'_�/_______.Distance to nearest lot lin--_,-._-_..--_ �E /I Len th of each line___ ` Width of trench.____ __________________ d Number of lines g �3-•� -- Type of filter material_-__Ab-cle_____Depth of filter material______1 _ ---_Total length------- _________��--. Sege Pit: Distance to nearest well._/Q�_.._.___Distante om fou dation__,/0.........Distance to nearest lot line_._____._-.- 9 Number of its_ ___Linin material_-_ Cie ' Size: Diameter____. --___.____Depth--_--- --------------- �J �f p �----- - 9 Cesspool: Distance from nearest well-----------------Distance from foundation____________ ______Lining material_-_-----.--.--.__________________ ❑ Size: Diameter---------------------------------------Depth--------------------------------------`---------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------.-----___._. ❑ Distance to nearest lot line------------------------------------- :------._.--:--------------------------------•-------------------------------------------------------- Remodeling and/or repairing (describe):--..-- NST14 Y,/-----JS--- ' - r - :------•-------------------------------- - ---------•-• ------ ------------------------------ ---- �� ------------�S F � W--------- - - - _ ----------- --------------------------------------- - ----------------------••---------------------------------------------------------------------------------------------------------------------- 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)I a --(Si ned)---------- --By:------------------- - r (Title) (Plot ,t 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------ -------------------------- DATE ------------------------- 1 REVIEWEDBY , - DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------ --------------–-------------------------------------- DATE----------------------------- ------- Alte�r-ations and/or recommendations ---- =--------- --- - - ----------- ------ --------=--------------------------------------------------------------------------------------- e - -------------------------- ------------------------------------------------ --------------------------------------------------•------------------------------------------------ ---•----------------------------------------------- -------------•- ----- -------------------- ------------------------- ----------------------------------- --------------------------------------------- -------- ------------------- -------------------------------------------------------. FINAL INSPECTION BY:-- Z _,I� ��7Q�----- Date-- = l 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.Cu.