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APPLICATION FOR SANITATION PERMIT Permit No. �� (Complete in Duplicate) /it 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 Count rgce No. 549. 1 r JOB Ag&RfSS ANtkee,_•�---- LATION------- --------- -J-•---------------••----------------Owner's ----- «--:------- :- - - hone Address-----------------•----------I _ s f *M Contractor's Name---- Ph 1 6pa4ment 1 onInstallation will serve: esidence.%, ouse ❑ Commercial' Trailer ourfi p Motel ❑ Other ❑ Number of living n Vis: ___i___ Nu fiber;,I6edrooms 2rNumber of baths __(----- Lot size ------- � � ------•--- -- -----•------------------------ Water Supply: Public system Community system ElPrivate ❑ •Depth to Water Table ft. I Character of soil to a depth o1_3;feet:• ,Sand ❑ Gravel E1 Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe 2, Hardpan ❑ Previous Application Ma. e: Yes ❑ No [] New Construction: Yes.E]: No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND.SPECIFICATIONS: . (No septic tank r'cesspool permitted if public sewer is available within 200 feet.) I tic T nk- Disfdnce from nearest well________________Distance from foundation-------------------Material_--____________-_ ___________. No. of compartments--- ---=----- ---- ---Size--_-----------••---_,3____�,--_Li uid de ;th-3_____-_----______-----_Capacity q 1 p -------- I D' osal Fie♦d: Distance from nearest w� __ ___. Distance from foundation._._Q_____,___._ Distance to nearest lot line_-_ __ y -------- � , Number o`f lines ------- _ __ - __-___Len fh of each line_--___ ___ \ 9 - K___.-__ Width of trench _ --------------------- Typ of filter material____I i. __ _Depth of filter ma+erial___ __ ----_-_____'Total length----- -_-- -_ � 4 �y fy Seepage Pit: Distance to nearest well......... DistanceMfLunci ion_.-.6_______.__1.Dto nearestI ling____Number ok p.s---__.-I____..___.__Lining material_____ _Size: Diameter.__ -C -----__Depth___ �Q-_ ---- --- -- - Cesspool: Distance fro -pea rest well__-___,_Distance from foundation________.___.____Linin'material________ -------------------------- El __________ ❑ Size:'Diameter ------------- -- -----------------Depth---•----_--------------------------------------------Liquid Capacify----------------------------gals. Privy: Distance from nearest weft---.________________ '_____ Dis+ante from neares+ building___:__-______________-------------------- Distance f'o nearest lot line ------------------------------------------------- Remodelin and/or re air= describe ) i i g / p Q(describe): ---------- . ". -•------- --------- =-----•-------------------------------- ------------------------ j- - --•- ¢------------------ ----------------------•------------------------------- - ------�'..--- t ------------------------ ' 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 r ``and regulations of the San Joaquin Local Health District. , (Si net �-�...;.. 9 ° ------ '- (Owner and/or - ----� ---- -- ----- ----- ---------------------- = O dorQCntracfr`�) By:----------------- ' ------------------ ---------�-------------------------------------- I -----------(Title)------------------------------=------------ ------------- E (Plot plan, showing size of lot, location of system in relation to wells, buildings, ec., can be placed on reverse side). a _ }---FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTEED BY---------------------- -"--- I DATE_.= 1 ------------- ----------------- REVIEWED BY # = i - A----------------------------------- - DATE----- - - -- ------------------------------ BUILDING PERMIT ISSUED ---------- ------------- - ----------------------------------------------------------- ----- DATE------ -- ---- Alterations and/or recommendations: •- - ----- ?s /12 O --- --------------------•---•--------------------•----------------------------------------------- -- ---- ---- - - --------- -------------- ---------------------------- ----------------------------------- 1. FINAL INSPECTIO ___ i ----- --- --- --,- --t--- --- - Date----- ---------- SAN JOAQUIN,LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO.