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q✓ nsu-�4 *APPLICATION FOR SANITATION PERMIT Permi+ No. ,� 1.__ 3 I I4^CaCC Q � (Complete in Duplicate) l This Permit Ex ires 1 Year From Date Issued Date Issued _______ 7 q 3 -(70-0_� Application is hereby made to the San Joaquin Local Health District for a permit to construct and instaaim This application is made in compliance with County Ordinance No. 549. S� �J � JOB ADDRESS AND .LOCATION ✓ted T Owner's Name ' ------------------------ - -----------------------------------------. Phone-------------------•---------------- Address "•7 /. ;70 - -- ---------------•----•---------------------•---------------------------------------------------------------- ------ Contractor's Name-------------_--Il� - ---- ------------------- --------------- Phor :f _r---- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms -------- Number of baths A"pot __/SD', .34D_�___________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tableo?_-S__ft. Character of soil to a depth of 3 fee+: Sand M__9�rlvel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No LZj_---FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �: Distance from nearest well_________________Distance from foundation--------------------Materiai----------------------._________..___..-- No. of compartments-- ----------------------Size-------•--------------------.._.Liquid depth--------------------------Capacity--------------------•-- U} f10, Di=posaiel : Distance from nearest well_ 4.._.__.-_Distance from foundation___1414_---Distance to nearest lot I`__S �� Number of lines-------- Length of each line---,614________ _______.Width of trench_.._- - ----------------- Type of filter material_ p -----Total length----------- _ ��..__De Depth of filter material_./19 Seepage Pit: Distance to nearest well------------------------Distance from foundation___________________ Distance to nearest lot line--------------- r ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------------------------' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------V._--�� ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----....--------------_______.__..____._.I ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------- ` 3 Remodeling and/or repairing Idescribe)-------------------- ------------------- ----------------------------------------•--------------•---------------------•-----------r--------------------- • -------------------------------------------------•--------------------- --------'-- --i`---------------"•------------------------ --------- --------•---`- i ----- ------------------ ----------- -------------------------------------------------------- ---------------------------------------------------------------------------- --------------------------------- I --------------------------- -I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5t ss,, and rules and re I tions of the San Joaquin Local Health District. (signed)____VG�"1 ,--4 _--__-- { caner and/or Contractor] + %__ gY: ---- - -- ------------(Title)---- ----------- ------------ (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY---- -- ------ ---- -- ----------------•---------------------- DATE f �4 ' REVIEWEDBY------------------------ ------------------ - -------------------------------------------- DATE------------------- BUILDING PERMIT ISSUED------------ - -------------------------------------•--•-----------------------------------------• DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------------- ----------------------------------------------------------------------------------------••----------------------------- -------------------------------------------------------------•----------- --.-.._------------------------------------------------------------------------------------------------------------------•------------------------- -------------------------------------------------------------------------------------------------------------------------=---------------------------------------------------------- -----------------•--------------------- --------------------------------------------------------------------------- -------- - --- ------------------------------------ ------------------- •----------------------------------------------------------- 1 4— FINAL INSPECTION BY:_.___... _. - .� Date.. --------------- - -('---n-------------------------------------- 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 E5�9-2M Revised 8-'59 F.P.Co.