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APPLICATION 1=0R SANITATION PERMIT Permit No. (Complete in Duplicate); �l _rf l] 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. s , JOB ADDRESS AND LOCATI N-------��--�`__-��------------- -------�..� -�f.�-c�J-------------�� - Owner's Name------------- -------- ----------------------------- ------------------------ ---------- Phone-----------•------------------------ Address------------------------- . ---- - -------- ------------------------------ ------------• --•------.._..----•--- ---------------------••- Contractor's Name--------_--------------- �lE � ......... Phone ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ ( Number of living units: __ _____ Number of bedrooms'_J... Number of baths _1-_- Lot size _---__'� ___.-_-----_--_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -410 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 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.) S tic Distance from nearest well-----------------Distance from foundation----.__-___---_-_._.Material___._______._._._-_____------------------------- No. of compartments----------- Size--------------------------------Liquid depth--------------------------Capacity---------------�---- r iso Distance from nearest well_____d Distance from foundation----_-Q __ Distance to nearest lot line Q P Number of lines______________�_ ___.______. __Len Length of each line----__ _-(� Width of trench.___=:_�c_ ------------------ Type . �"� g Yt �--------------- �� Type of filter material------ of filter material-- Total length_____ ___________________ Seepa. t: Distance to nearest well._.__.!_V�,-</t3istance f m fou dation___•/-6)--------Distarick1to nearest lot line__,..��. ..__.._ Number of pits--.--_-_.-{-.___._ g rr�c,�__ _-.Size: Diameter__ i�.___._ Depth_______ j� Linin material._- _ - -- --- -�------------ LLCesspool: Distance from nearest well----------------_"`Distance from foundation--------------------Lining material------------------------------------- Size: Diameter--------------------------------------De El Liquid Capacity uid Ca acity gals. P G p Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.---------------.--____--.._-..------ ❑ Distance to nearest lot line-------------------------------------------- - ------------------------ ------------------------------- ------------------------ Remodeling and/or repairing (describe)= c "- `. ------------------------------------ -- ------------------------------ --- ------------------------------------------.----------------------- -------------------------------- -------------- I hereby certify that I have pr {pared t ' applic tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule n reg ations the San Joaquin Local Health District. (Signed)-------------------------- — ----- -- - - -------- ----- - ------- �� w and/or Contractor) _.__ Owner B �. ---------- ---(Title)-------- ► y:--•------------------------ - - - -- 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 . APPLICATION ACCEPTED BY ----------------------- DATE------ / -- --------------- �. REVIEWEDBY------------------------------------ ------- ----- ----------------------------------------------------------------------. DATE------- ------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations---------------- ------------------------------- ----------------------------------- ---------------•----------------------------------------------------------- ------------ r---------------- - --------- •- ----- ---- •- .. ..--------------- -- U r � -----: --:.:::::.__:: ::::-------:::::-------- .�_4 I ------ F ------------------------ g� FINAL WSPECTION BY----- ----------- .., Date.- ----- Cr SAN JOAQUIN LOCAL HEALTH DISTRICT V 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 8-'59 F.P.Co.