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aj I Q� APPLICATION FOR SANITATION PERMIT hermit No. ...../._.U.., 3 1 (Complete in Duplicate) Date Issued -----_ �--7 __°4 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. _ -------= p ------------------- JOB ADDRESS AND LOCATION___._ ..�--�.----�0_+--�--�. . ,� �'-� �'� k�____/_!._..-______ Owner's Name------- n ' ------ Phone..�T-® Address------------------------•-•- / ��p f -------•--------------------------•------•---------------•--=----------•----------------•--•----•----------- Contractor's Name----TT,can_ -�F Il. l -tr .-- -[-,�--------------------------- Phone_ _., -��1- - Installation will serve: Residence %,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms -_I___ Number of baths __.I-. Lot size _ _ -_.l_- -_ .�---- --------- Water Supply: Public system ❑ , Community system ❑ Priva+eU Depth'to Water Table Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe D!� Hardpan ❑ Previous Application Made: Yes ❑ No,64:--. New Construction: Yes ❑ Noj�L. -FHA/VA: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S #ic Ta kti Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. _____-_______-____---._---__----..___----___- No. of compartments--------------------------Size-------------- ---- _-__----Liquid depth---------------- -------- Capacity--•-------------------- field: Distance from nearest well�a-------Distance from foundationti ---- ______01stpnce to nearest lot line----__- Number of lines----/______________ _ ____ Length of each line___----_ -. _�_ _____. i tt of trench___ _ __.. __ __.�R-� T e of filter maferial_��A- --De Depth of filter maferial n YP p ---- otal length-------- ---'------------------ -----�-� �+ EtSeepage Pit: Distance I_________-._.__- Distance from foundation____________________Distance to nearest lot line_.___________..._um er of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material------------------------------------- E-1 Size: Diameter-------------------------------:------Depth----------------------------------------------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest well------------------------ --_-_Distance from nearest building_-____._____________----__-_-..--_---. ❑ Distance to nearest lot line---------- ------------------------------------------------------------------------------------------•---------------------------------------- Remodeling and/or repairing fdescribe):--- -----------------•-----------------------•----------•--------------------- 4_ ___ 4 - - - -------------------------------- ------- --------------------------------•---------------------------------- ------------- --- - ------- ________ - --- - -- 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. �14- J i�C F Contractor) IBy:-------------------------------------------------- -- - fe -. - -------------(Title)---------------------- ------------------------- ----------- - '(Plot plan, showing size of lot, location of system in relati to-wells, buildgs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY------------------ -- -- ----------- ------ --------------•-------------•-------------- DATE ----------------- REVIEWED BY DATE ! ` - --------- ------------- BUILDINGPERMIT ISSUED_.------------- ------------------•--------•---------------------------------------•--------------- DATE-------- ------ -------- ---------------------------•- -- Alterations and/or recommendations------------- --------- ----------------•-•--------------------•----------------------------•------------------------------------------------------- -- ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------•---------------------------.... ------ ------- --- --- --- ---------------- ...... - -- ----- - -- ------ ------------- --- -- ----- --- --------- -- ---------------------------- ------------------------------------------------- --------------------------- FINAL INSPECTION - Date- L2---_- r SAN JOAQUIN LOCAL HEALTH.DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 0-'59 F.P.Co.