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FOR o��E usF: �------------- fes --------------,-. APPLICATION FOR SANITATION PERMIT Permit No. .. ..4-` -------------------------------------------------------- (Complete in Duplicate) 7 This Permit Expires ] Year From Date Issued Date Issued .--..-....." 6-1 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 LOCATION. �°r •' l -------------------- -----------------------------------*-------------------*---------------------------- Owner's -------- ------ Owner's Name--r r(f� /� ..-k �� C."`--- ------------- ------------------------------------------ Phone----/?_(...5;sYfA. Address1;7 ------------------------------------------------------------------------------•--------.......------------------•...---------------•------------ Contractor's Name ------- -------------------- ------------------------------------- ------------------------------------------. Phone.................................. Installation will serve: Residence ❑ Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----.-. Number of bedrooms -------- Number of baths. Lot size ..... Q--_X- -. 0-------------------------- a Water Supply: Public system 19 Community system ❑ Private ❑ Depth to Water Table-7 - ft. Character of soil to a depthof 13 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Up Hardpan ❑ Previous Application Made: (If yes,date---------------------I No New Construction: Yes ❑ No [V FHA/VA: Yes ❑ No (� TYPE OF INSTALLATION AND SPECIFICATIONS: % (No septic tank or cesspool permitted if public sewer is available within 200-feet.) Septic Tank Distance from nearest waif---------------- Distance from foundation---------------__---Material---- ?' _ -----___------ w No. of compartments............2,,,--------Sizeff,X.6_1A-*.........Liquid de th__-----}-...__-..--- .Capacity Y� Dis os ,Field: Distance from nearest well_-�t�= - Distance from foundation--------------------Distance to nearest lot line----------------- ?lov Number of lines------•---/----------------------Length of each line-----_X! ------------Width of french---------- Y-r ---Depth of filter material �--_----__-_-Total length __ � Type of filter material._ �"�� p g �(� __ Seepage Pit: Distance to nearest well__'71tY1�_-_-_Distance from found tion---�_�-(�._--.Distance to nearest lot line--- - ------- 0 Number of its---._- - ---Linin material- -- ___. !� �--------=- g �-- ize: Diameter-_'-,q- -//-------- Depth---a-3,/------------------- Cesspool: ---------------- 'Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------.-.-_---_-------.- ❑ Size: Diameter--- ------------;;---------- Depth----------------------------------------------------Liquid Capacity_------------------- gals. Privy: Distance from nearett well---------- -- -----------------------------------Distance from nearest building------------------------------_----------- El ---_-.❑ Distance to nearest lot line------- f Rem eiing nd/or r pairing (descri :_.�f' -- __-- ----------- ---- - #------. ------------------------------------•---------------•---------------•-------------------------------------•----------------------------••--------------------------------------------------------- -----f- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rule and regulations of the San Joaquin Local Health District. / Al (Signed) =`- V------------------------------------------------- ----•-------------(Owner and/or Contractor] By:------------------•---------------------------------------------------------------------------------------------------------------(Title)------------------- -- (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------------------------------- DATE-----..V--- REVIEWEDBY---------------------------------------------------------------------------------------- ------ DATE.. BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------• DATE. Alterations and/or recom 4 d tions •----•---------- ------------ F 4, ---- --------- -- r r FINAL INSPECTION BY:---- ..--t - •--- �Z�'rz� -- ^`s �f Date---------------..... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E19-9 REVISED 13.59 r.P.c0.2M 6-60