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�\ APPLICATION FOR SANITATION PERMIT Permit No. — (Complete in Duplicate) Date Issued ____ This Permit Expires 1 Year From Date Issued ' w 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. JOB ADDRESS AND . J�L --------- Owner's Name------------ • ----------- -------------------------------- Phone--------------- ----- • •-•-•-•----•-- Address-- --------/ T.J/d------- ---- ------------------------ -- .------ - ----------------- ------------•-•------------•------------ Contractor's Name-------------- � �f�1. ------------------.--------•------------------------------------------- -- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑-,Motel ❑ Other ❑ i Number of living units _,-__ Number of bedrooms__ Number of baths/f,- Lot size _____________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ Zft. I` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®-- Hardpan ❑ ! Previous Application Made: Yes ❑ No 2"� New Construction: Yes 921**N' o ❑ FHA/VA: Yes 4�0' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) > 999 Septic Tank: Distance from nearest well---- Distance rom foundation___ _______..Matial________ _�/___-- "A - ------ [ No. of compartments______ .e_____________Size_v_-_dl`__4-09_-___Liquid depth_____4 __.-...-______-_Capacity.. I Disposal ield: Distance from nearest well-... "___._.Distance.from foundation___-_f0_ ____Distance to nearest lot line.- ...... s� '-- ., o, � Number of lines---•---- -P`!---------------°"'-L'ength-of-each-line-----��._---=--_--.Width of trench----A�-.----.................V.1 Type of filter material/��-��__Depth of filter material----If�---_____Total length--------��' ---- _____________- Seepage Pit: Distance to nearest well---- ,QQ-------Distance from foundation___- Distance to nearest lot line----4w_--_- � Number of pits'___------------Lining"' material.._,_j9lr�-__/�_J---Size: Diameter-___v�f�____-Depth---.�o��_'_ -- ---------- - Cesspool: Distance from nearest we}I------__. _�----Distance from fou ndation--------------------Lining material--------------------___-__----_____-_. { p Size: Diameter--------------------------)--------Depth------------------------'--- ----------------------Liquid Capacity---------------------------gals. Priv Distance from nearest well_________--_'- --------------------------------._Distance from nearest building----------------------------------_----_. ❑ Distance to nearest- lot line-------- -------------------------------------------------------------- ---------------y ------------------- jjj000 r Remodeling and/or repairing (describe)---------- ------444 -------•-------------------------------------------------------- ------------)-------------------------- w q 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 a d regulations of the San Joaquin Local Health District.` x , - }_: =-------- ----- �r Contractor.'. (Signed) �. A BY• L -------------=---------- (Title)--- 1r = --- ----- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). _.,'FQR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY - DATE: . `� rff 0J----------- � . f REVIEWED BY--------------------------------------------------- ---------------------- - DATE-- BUILDING PERMIT ISSUED -= '---------------- DATE------------------------ -------------- Alterations and/or recommendations:-----------------r------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ` ____ __________ _ _ ------- - _ _-__-._____________ -_ .-___-___ __•--------------------------- V __________.______.____ -_.___ _______- �/� __ �"� �..,C� ------------ -------- - - -- ------------ � "- ---------- - - /` 5� .9- '--��--/-----`' FINAL INSPECTIO :-_ ` 1 �.� -�--------------------------------------- �� Date------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300�West-Oak Street i �' e1• X132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California M i ES-9-2M Revised 8-'59 F.P.Co. w