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�� • APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued 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. 11 Q iI ' - -------•--------••------------ --------=-------- JOB ADDRESS AND LOCATION----__-�-- - rJ ---- --------- Phone_.f v_ - ."' 7_- e 1 k • _______________________ OwnersName---------------••--•- -- - -----•--•--..---------------------- - ---------------------------------------------------------- •---------- Address - - Contractor's ame------------------------------------ - -----•--. •-- -------•- -- --- ----------- ------------------•------ Pone-- -•-- • - �_--- Installation will serve: Residence �Partment House ❑ Commercial ❑ Trailer Court ❑ Motel.P. Other ❑ __ i ----- Lot size --------- ------- -- -- --- -------• -------------- Number of living units: _j--- Number of.bedrooms - / Number of baths "-� Private ❑ Depth to Water Table 3J�_ {#, Water Supply: Public system Community system El Sandy Character of soil to a depth of 3 teat: Sand ❑ Gravel ElSandy Loam ❑ Clay Loam El Clay El Adobe Hardpan [IPrevious Application Made: Yes E], No � New Construction: Yes Ur No F-[ FHA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , stance froirl,foundation_ _"_o---.- --� Materia)----- Septic Tank: Distance from nearest well_ i i Liquid d de th__. �7�-....___.__--Capacity.___ -- ® �,[,r/Il No. of compartments-------- �- Size_ ..X_�? -- q P. lot line Disposal Field: Distance from nearest well_ Distance from foundation. - -.Distance tft+rendre cA 41$t - J...................~`7 `. L n th of each line__-- ------ ---- Number of lines_-__________ ------ --------- g "! th of {filter material_____/_-�Q ---;-dotal length-------- -`3------------------------ Type ---"-------------- Type of filter material�3 �,------ P ( - Seepage Pit: Distance to nearest well__________________--Distance from foundation_____-________.:_-".Distance to nearest lot line Number material-----------------------Size: Diameter_=------------ --- ----Depth-.------------------------------- F1 ------------------------------ Q i ❑ Number of pits------------------ - g ing rial Cesspool: Distance from nearest well---------------•-Distance from foundation.- ---_-------'-_Linuiti Cateacit "" gals. ❑ - Size: Diameter-------------- ------- -------- ----Depth------------ ---•------- 9 P Y----•------------- --------- ------------------------ --------Distance from nearest building----------------------------------------- Privy: Distance from nearest well___.__.___._- - - ❑ --- -- ------- Distance to nearest lot fine--------------------------------------- � r Remodel an /or repairing (describe):------ �'�J--- ------- .e-!_------- -- t` ------------------ -- ----------------------------------------------- ------------------------------------------------------------------- --------------------------------------•---.---------,- ---------------------------------------------------------------------------------- - ------- ----- 1 hereby certify that I have prepared pplica+ion and that the work will be done in accordance with San Joaquin Coun+y ordinances. S s, an rules and r ulat' s of the.San Joaquin,Local.Health Disti•ict.— ---- - ----------------------------- (Signed) _____.-(Owner and/or Contractorl ---- ------------------•------------------------------------------- 'r ----------------------(Title)--------- .............................. --------------------••------ ----- --------------------------------------- (Plot plan, showing size of lot, location of sys+e m Tela+ion +o wells, buildings, etc., can be placed on reverse e e. FOR DEPARTMENT USE ONLY )_ 7_4 07 DATE �T-"'1- G APPLICATION ACCEPTED BY__." - - � � - ----••- DATE-- •----•------ -- ----------------------------------------- REVIEWEDBY----- -------- -------- - -------- --------------------------------------- ----------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------•---------------------- DA7E ---------\--------------------------- - Alte--r-a--t-i ---------- -- Alterations and/or recommendations:---------- :--------------- 2--------- / --- ---- ------- ._l - "•----- ---- ----------- -------- ------ ------------------------ ------•------•------------------ ------- ------------- --------- ------------- -- ------------------- o'-' 7 M1 4 ------ --------------------- FINAL INSPECTION � Date----y---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Manteca,~California Tracy, California Stockton, California Lodi, California ES-9-2AA Revised 0-'59 F.P.Co.