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I ' APPLICATION FOR SANITATION PERMIT Permit No. ...I; %1�� (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued . I Application is Eiereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiol is made in compliance with County Ordinance No. 549. Z�- 91 `-( - .tit E2Sd / JyADDRESS:AND LOCATI..ON -All�-i---_..... ._ _�/�__�__✓'L '!� ------ Owner's Name��- _ " ------------------------ Address Phone_.....-. IIID ��` --`"---•-------------------- ------•-•-----•-------------------- Contractor's Name-- ---------•----------------•-------------------•----------------------------------------•-------------------------- Phone---------....__.--•---------------- Installation will�'serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numbe' of living units: _L_____ Number of bedrooms _a2--__ Number of baths -1----- Lot size .__f _ '.1 .d______________________________ I Water Supplya.i Public system E] Community system El Private X] Depth to Water Table &Z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No �E 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.) f I Septic Tank: ! I Distance from nearest well--,'y'* - _Disfia �� foundation--l-0 ��__ ---••---------------- - No, of compartments-_#?—-----------------Sizer--------- -rte------------- Liquid depth `T Capacity II � , Disposal Field: ' Distance from nearest well...,ar'__Distance from foundation...!�.+_____-_-Distance to nearest lot line__i��____.____. ! Number of f Ines________ _______ Length of each line___ Width of trench ------------------ ` i Type of filter materia, 4i-- Depth of filter material__! ---y'______-_Total length_________ __________________________ Seepage Pit: ' Distance to nearest well._/� -----------__ _ Distance from�foundation-,?-4a+ ' .l_...____.Distance to nearest lot _J_�____ -.. F Number of pits____)----------------Lining materia _ h<1r Size: Diameter____33"--------Depth__. _ _._ ___-.____ Cesspooi: Distance from nearest well-----------------Distance from foundation.-.-----------------Lining material--------------------------.-__-_..___ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------.__-.___-._. ❑ Distance to nearest lot line------------------------------------------------ --------------------•- -------------------------------------------------•-------------- -- -- I s Remodelingal''d,or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- -----------------------------------------------------•------------------------•----------------------------------•------------------- ------•-------------------------------------------------------- 'IMf -------------------------------------------------------------------------------------------- --•------------------------------------------------------------------- -- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- I hereby I1certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stete-laws, and rules and regulations of the San Joaquin Local-Health District. (Signed} -----------------------------------------------------------------------(Owner and/or Contractor) F $y:---- --- ------ ----- - - = (Title)) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIO N�- ACCEPTED BY- :- - II ------------------------------------------------------------- DATE_"_�'__----�----------------------------------- - - -�__-_ REVIEWEDBY--------------------------------------------- -------------------------------- ------------------------------------------ --- DATE-------------------------------•---•----------------------- BUILDING PERMIT ISSUED-------------------- ------------------ DATE------------------------------- -------- -- Alterations anld/or recommendations:_-_- ----------- `---------- -•------------------ `�� ----- - ----- ..__ - ------ -------------------------- ----- F. I ` - _: - .-------- -V----------4 ------------------------------------------------------------------------------------- •-- -•-'--------- =1 �"-v -------------------------------------------------- --------------- --- ------- -- ----------------------------III! ------------ ------------------------ ------------------------------------- - --------------------- ------------------------ ------ FINAL INSPDate__ _ "'742—-7"' ---------------------- ECTION BY:., .. . -------------- 57- 7� 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 11 ES-9-2M Revised 8-'59 F.P.Co. P