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/' } 7� -+. APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued __- Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install the work he rein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ __ —----------- t Owners Name----------- K--------- -------------- -- ---------------------------- --------- Phone--- -- - --��Z3 Address ; e>' F s � - '{-- -------------------- ` 1 --------------------------------------------------------------------------•--------- --- --------- --- ---------------- � 1 Contractors Name = != ' ------ =------------------••---------------------- Phone----------------------------------- Installation ---•----•-------------•--------- Installation will serve: Residence14 " Apa.Rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 1 Number of living units: ,_______ Number of bedrooms --p_Number of l3afhs -------- Lot size ----------- _ Water Supply: ,Public system E] Communi y system C-] Private K Depth to Water Table?� ft. R j Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loar{i❑ Clay Loam ❑ Clay ❑ Adobe JR Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes No ❑ 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 well---------- ;___Distance fromifounclation__.__' ----------Material_______________________________________________- No. of compartments s 11`I� p _._._Liquid,depth Capacity Disposal Field: Distance from nearest well_--------------1Distance from foundation--------------------Distance to nearest lot line________________ Number of lines-------------------------- ------ )Length of each line------------------------------Width of trench---------------------------------- J Type of filter material-------------------------DEpth of filter material __.____._____---------Total length----------------- ------------------------ Seepage _____________________ • ! f � �� p Il_In�vl±__{0_0__Distance afro foundation------ _______F Distanc�r to nearest lot ` }Seepage Pit: Distance of nearest �- '-+----Lining materi'al_r ,__ _fit .Size: Diameter____ 2�._._____Depth____' ,;'r' _____-___._ Cesspool: Distance from nearest well----------------- from foundation___-___.._________.Lining material__.____------------------------------- Size: _...__.___'____--__________. E �.,ri 5.• ❑ Size: Diameter---------- ----------------Depth,.------------ ------------------- -----------------Liquid Capacity-...,--.""-----,-,-,?------•-gals. Privy: Distance from nearest well------------- --------------'---------------------Distance from nearesf building------------------------------.____.___. ❑ Distance to nearest lot line -------------- ---------------------------•----------------------•-------------,----------------------------------------------------- Remodeling and/or repairing (describe) - �_ Ld..t`ta � ea E tiR --------------------------------------------------- Y ---------------------------------------------------------------------------------------------------_ I hereby certify that I have prepa5'ed this"applicationa;d•i that fhe 6i will`be donelin accordance with San Joaquin County q ordinances, State laws, and rules and i gulations of the San Joaquin Local Health District. - s (Sign ------------------------------ ------------------ --------------- -----(Owner and/or Contractor) By: ------- ---------------------------------------------------------------------------------(Title}------------------- - -- f (Plot plan, showing size of lot, location of system.in,relation,to;wells,`buildings etc., can b" placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-...- ------------------------- DATE._________ -- - ------------------------------------- -- ----------- ---- -- ---=---------- 1 C e .� Cf/ r1' REVIEWED BY------------------------------------ --i 1--- ----- --- ------ DATE--------------- ---------------------- --- --------------- BUILDING PERMIT ISSUED----------- -------I--------------------------------- ---- -------------------------------------- DATE------------------------------- ----------------------------- Alterations and/or recommends#ions:_-- w.-------.,„..---------_n------- i -• - - _:- --- _ —. - ...._ . -------------------------------------------------------------------------------------------------- - ------ ------------------------------------------------------------•------------------------------•----------•-•-------- i ------------------------------------------------------------------- --------------------------------------------------------------------•-------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. --------------- ------ Date.---- �l- i? 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 6-'59 F.P.Co.