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APPLICATION FOR SANITATION PERMIT Permit No. .._.�1, _' _�_.. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 3�3�� = pplication 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. it i1 JOB ADDRESS AND LOCATION__..-..2.6 Q_- Owner's Name--------- '{ e - Phonel7- ' / � --------------------------------------- Address________________ •------- -------• ---------------- Contractor's Name :4'----�¢lZ.cyjta-----��1, elr------------------------------------------------------ Phone- .. �P._ Installation will serve: Residence g_ Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__- Number of bedrooms ___�umber of baths ________ Lot size ____5i__� --- Wafer _`Water Supply: Public system JX Community system ❑ Private ❑ Depth to Water Table__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L& Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ NoA FHA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitte&-if public sewer is available within 200 feet.) tip_;N:,k_ Distance from nearest well_________________Distance from foundation--------------------Material -.____________.________---_.___.____.._.-_-_____. No. of compartments--------------- ----------Size-------------------------------Liquid depth-------------------------Capacity------ --------------- D's osal F' Id: Distance from nearest'welL.A_p 12_--Distance from foundation-__�` .._...Distance to nearest lot Number of lines___._-_� tl_____--_-------Length of each line____?�./__--_ ------ -----.Width of trench-----�-�....................• 4- !+ d d Type of filter material_ E� -___._____Depth of filter material___ �� g �- i � p ��---------Total length - Q------------------------------ Seepage ------ ------------------Seepage Pit: :Distance to nearest well---ft1S7,<<-------Distance from foundation-----/.Q---------D tante to nearest lot line-"-_,.____ 0 Number of pits---------f-------- - Lining material__+ " - -- - ----------�---- Size: Diameter.---- -=- --..........- Depth------�--`�-�--------- ---- Cesspool: Distance from nearest well_________________Distance from foundation------------------. Lining material------..______-___._____----___.___ ❑ _ . Size: Diameter_________ -----------_ -------.Depth------------------------------------------ - ------Liquid Capacity---------- --------------•-gals. Privy.:,: Distance from nearest well-------------------------------------------- ----Distance from nearest bui{ding_________.__-__---- 1� ❑ Distance to nearest lot line----- ------------------------------------------------ -------------------------------------------------------- ------------------------------- Remodeling and/or repairing (describe):---_.__ -------------- ______________ ------------ _ ------------------------------------------------------------------ _Z; ------ l '' --------------- --------------------------------------- ---------------•-------------_--------••-------•--------------------------- -----------------•----------------------------------------•-------- ----------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------•------------------------------ y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, St laws, and rules and regulation of the San Joaquin Local Health District. VL_ t----�---`-- 'j -- .. i-- -- (Signed) = ----- ---- ----- ----- - -- _ r Contractor) Sy:-------------------• ------------.------------------------------------------- -- ----(Title)------------------- --------------------- --- -------------- -- (Plot plan, showing size of lot, location of system in relation to w , buildings, etc, can be placed on reverse side). -_,FOR-DEPARTMENT USE ONLY :,4 APPLICATION ACCEPTED BY �'� ---------- DATE , 6' --------- REVIEWED BY------------------------------------------- - ----- -------- --------------•-------------------------•-------------- DATE-------- ------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------••------ --------------------- DATE.------------- Alterations n /or recommendations:_ _ - - __ - a ------------- -----------•--------•--- 3_- -6--- --- - -------- ------------- ----- ' G -------- ----------------- ---------- -- ----- ------� � f .�'r - --------------------------- --------------------- ------------------------------------------------- -------------------- --- - •-------------------------/-- _ �, _ -------------------- ---- -------------------------------•--------- ------------------------ ---------------------------------------------------- FINAL INSPECTION BY: _..e. ____ `,(.. - -----+ - 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 s`. Tracy, California ES-9-2M Revised 8-'59 F.P.Ca. +