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, r4- 31 APPLICATION FOR SANITATION PERMIT- Permit No: ..... (Complete in Duplicate) Date issued - -/_-La"-_ " 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 o. 549. JOB ADDRESS AND L ATION____ �__� -_.__ _ " _ ------------------------- Name ----------- ------ ---- ---- Phone------------------------------------ Owner's Address �I /----_------- }_. Contractor's Name , i . 'a` ----------------------------------------•---- Phone ---------------- ----------- = Installation will serve: Residence �Apar'tment House ❑ ;Cgmmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1___ Number of bedrooms __%L'_ Number of baths ___ ___ Lot size ._ -,?�.--1L�---------------------------- Water Supply: Public system Kll�ommurii#y system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand-Ej Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan p Previous Application. Made: Yes ❑ No P<New Construction: Yes ❑ 1--;No �HA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPEC IFICAT'IONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well'`---- Distance from foundation___________________Material------------------------------------------------- r�y No. of compartments------- '---- -----Size--------------------------------Liquid depth--------------------------Capacity----------------------- Dispc, al ielcl: Distance from nearest well-________________Distance from foundation_______________-__-Distance to nearest lot line----------------- ;Number of lines------------------ ------------.__Length of each line------------------------------Width of trench.---------------------------------- 1 } Type of filter material--------3_L_-----------Depth of filter material-_________N---------:_Total length______________________________ ,r Seepage Pit: Distance to nearest well-=`___=!___'------Distance f m ndation_,(�e-______1-:D's+ance to nearest-lot line----/Q_�..- tel' p' g -��- Size: Diameter_ �1} y Number of its Linin material ------ ��-------Depth-- Cesspool: Distance from nearest well__'--------Distance from foundation____________________Lining material__-_____________________-__-____-_- V ❑ Size: Diameter-------- ------------------------------Depth---------------------------------- ------------------Liquid Capacity----------------------------gals. Privy: Distance from inearest well----_—I-________________________.._______--___-_Distance from nearest building---------------___________________.__---_. ------------------- ❑ Distance to nearest lot line------------------------------r- - -------------- ----------------------------------------------------------------- Remodeling and/or repairing (describe):---------- �±� -------- __:------------------ ------------------ ----------------------------------------------------------------- t --------------------- ---------------------------------------------------- ------------------•-•-•---------------•-----------•-------___------------------------------••---------------------------------------- C 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. ` (Signed(------------------------------ ----------- ------- ------------------`-----------------------`7. --------------------------{G�ee�-a�d Contract or By:------------------------------------------ ---- --�1rL� `= -----------------------(Title)---- �_�1 ------------------ (Plot plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- �.--I ---P '-_-_ ----------------------------- #-------------------------- DATE......-.1x-3--_f7� � ------------- REVIEWEDBY-----------------------------------------------------------------------`--------------------------------------------------- DATE-----------------------------------••--•-------------------- iBUILDING PERMIT ISSUED----------------------------------------•-------------------------------------•--------------------- - DATE------------------------------------------------------------ Alterations and/or recommendations:_______-__----------------------�_lC ------------------------------- ------ 'i7=-------v�.Vrh----- a .------` L ------ - ------------------------------------- -•------------------------------------------ --------------------------------------------- -------------------------- ---------------------------------------------•-----------------------------.1---------------------------------------------------------------- ------------------------------------------ - --- ----- ------------------- -------- --- t FINAL INSPECTI Y: - ----------- -------- L Date-------11.1—_ 0.7:7" ` SAN JOAQUIN LOCAL HEALTH,DISTRICT 130 South American Street 300 West Oak Street ; ✓ F32 Sycamore Sfree+ 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.