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APPLICATION FOR SANITATION PERMIT Permit No, 1 1A.5. � -. .... (Complete in Duplicate) This Permit Expires 1 Year From Date llisued"' Issued ___ti................. [ 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. ��} l JOB ADDRESS AND LOCAT ON = � GC , �%--�_. <. Owner's Name ------•-------------------G__s-.tr�----•--•--- ---S-x---------------------- ---------------------------------------- Phone----r `_-'_--`--- kc Address-------------------------'------------------------........ - -••- ---------• -----------------------•----------------------•----------•-------•-•----.---• ---------..--•-•- Contractors Name' --•---------------•----••-•------------------------`--------------- ---------------------------- -•------•------ Phone----•-••-------.:-•--- ------------------------------------ Installation will serve: €Residence d�Aparfinent House 0 Commercial E] Trailer Court p Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrooms ___72—Number of baths' _ Lot size _____.. ©K- ______________________ f � •� Water Supply: Public system Community system ElPrivate E] Depth to Water Table ---- fft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ lClay Loam E] Clay ❑ AdobeA Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No FHA/VA: Yes �❑ No„w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f I Septic Tan . Distance from nearest well _-_fDistance fromyfounday tion--------------------Material____.______.__________-------______________-___-- ,i✓y No' of compartments------------- ------f----Size---------------•------------ Liquid depth------------i---------._Capacity----------------------- Disposal ---------------------- 1"� Dis oral Field: ------ Numberlines earest Ih F--- Di Length of each line foundation .____.Disfante to nearest lot line.... _-_____ p ----------------•----------.Width of french--------�--�----=-- t 'Type of`filer material_ __._ ._.________ _ Depth of fitter material____--__� _-_.----Total length___'__-___________` _�---_-__-- Seepage Pit: Distance to nearest well:---0---::—_! ____Distance from foundation---h__....---�Distance to nearest lot i e___-_-._S T-- Number of-Oft------------1 t�___,___-Lining material----- Diameter_' De th_ 6 _ __________ Cesspool: `V Distance from�ne.,arest wel_________________Distance from foundation.__._._.______.__._ Lining material_ ___..__-___--__-__._______._______-_. El Size: Diameter--------------------------------------Depth___________._--------------------------- ----- Liquid Capacity---------------------- •--• gals. q Privy: Distance from nearest WeIll----------------- '.__'-w-_---__________Distance from nearest building------------------------------------------ 0 Distance to nearest lot line-=-----------------------------------=-------------------------------- -- ---------------------•---------------------- Remodeling and/or repairing ----------- l € k 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 rules and regulations of the San Joaquin Local Health District. y � (Signed) t V --------1+------------------- ----------------- (Owner and/or Contractor) B .---- ------ , ' ' �' Y' �.�-�-- -rte. . ---------------(Title)------------------- -------------------- --- ------------------ (Plot plan, shSwing size of lot„Iocatio syste tion to wells, building(s, etc., can be placed on reverse side). 7 FOR DEPARTMENT USE ONLYx APPLICATION ACCEPTED,BY�-----------f--------------- oma ---_-_-----------+� +-------------------- DATE----•-----• ---1.4--_� Vd-1 - - - ---------------- REVIEWEDBY------------------`--�'---------------------------- - --------------------'. -: � DATE BUILDING PERMIT ISSLIED4_j.-•------------------------------- - � - = � -------------------- DATE---------------- ----- -------------------- -------------------------------------------- Alterations and/or recommendations_________ ________': ____--__ #r____ 'r_____._f.__ -•----------------- ----- ._ -----•---------------------------_---- - ------•----- --------------- --- 41 --- ---------------------•-•----- { --------------- -------- --- ---------- InD FINALINSPECTION $Y----------------------------------------- -------- ------------ Date.------------ -----' - ------------------------- ----------- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lod% California Manteca, California Tracy, California ES-9-2M Revised 0-'59 F.P.Co. r