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. Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ._____ This Permit Expires 1 Year From Date Issued V Application is hereby made to the San Joaquin Local Health District for a ermit to onstruct an ins�ll the work heroin describe V. . This application is made in compliance with County Ordinance No. 549. E �2 , "- , -S2-30 F.. H i 64V-1)4 y ` JOB ADDRESS AN L CA -. ------ - -- -- -� ---� .� - ---- Owner's Name---- Address + - -- ---- ----- - ----- - Phone. -- 7 ---6--19 y ---•-•---- -4--- - -•--- ----- ------- ------ _ 1 --------------.-_ f �� ) Contractor`s Name__ �� '' -��'-�'-�-- Phone. `__..1._Q----- �x��y --------- • -- - Court Motel Other ❑ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ T oiler C ❑ ❑ Number of living units: __ _ —-I____ Number of bedrooms Number of baths -_.1-__ Lot size ___-70-.-_X ---------- ------------------ Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam [I Clay ❑ Adobe F1 Hardpan ❑ Previous Application Made: Yes E] No� New Construction: Yes ❑ IK FHA/VA: Yes ❑ No/k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material __________---.__._______.__..--__.._________. W ❑ No. of compartments--------------------------Size---•--------------------- ------Liquid depth--------------------------Capacity----------------------- G Dispos l Field: Distance from nearest well-AC------Distance from foundation.._._____ - Distance to nearest lot line-----Z------- m ____ Length of each line____--____ _s Width of trench_____.v2___,_...___.______.___. Number of lines----- ------j ------------- g �------.�------- � Type of filter material-___-. Depth of filter material____._1.8_ _____..Total length___._7.S_._----_-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El dumber of pits----------------------Lining material---------- ------------Size: Diameter---------- -- ---------Depth--------------------------------- Cesspool: Distance from nearest well________________ Distance from fou`ndation--------------------Lining material--------------------__._._____-____. ❑ Size: Diameter--------•-----------------------------Depth------------------------------------ ---------------Liquid Capacity-------- -------------------gals. q� Privy- Distance from nearest well-------------------------------------------------Distance from nearest building---_----:--------------------------------. ❑ Distance to nearest lot line--------------------------------------------------------------------••------------------------------------------------------------------------ V Remodeling and/or repairing (describe)------------ --- --- ------ - ----------------------- ---------------------------------- 16 ------------------------ -----------•-- -------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. - ------------------- --------------------------------------------(Owner and/or Contractor) --- - ---- ---- -- --- - --- ----- -----(Title)-------------------------------------------- --------- By:-------------------------- - - ----- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ; FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --------- -- -- ---------- - - ------------------------------------------------------------ DATE 1? REVIEWEDBY---------------------------- ---- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- -------------------------------------- DATE--------- ------------------------------------------------ -- Alterations and/or recommendations:---------------------------------------------- ----------•-----------..-.-------•----.------------•-------------------- ---------------- ------------------ ----------------------------------- - ------------------------•-------------•------------------------------------------------------------------ --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- -------------- -------------- • ---------- Date--- ..�' -�0---------- --- ----------------- ------------- FINAL INSPECTION $Y�_ __:�^•,��------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Caiifornia Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.