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i�, 6fl APPLICATION FOR SANITATION PERMIT Permit No. ...l. • -` _ ___ (Complete in Duplicate) f r V Date Issued .__._- J 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. :23 6-72-- OZ-0-0 JOB ADDRESS AND LOCATION.____; .:--«--- -� = _:: : _ .___`______�" r _.."- Owner's Name----------------- - - - ----------------------------------------- - Phone----------------------------------- Address---------4--29--4-{---- -------------------------- -------------•--------------------•-•-------•-------------------------------------------------------------•---••---- "' '------------- Phone. Contractor's Name-------- - ------- dV-------------------------------------------------- x. Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms Number of baths �Lot size .--�__ ---'__________________-_____ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _4/ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay R Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No�New Construction: Yes �No❑ HA/VA: Yeslo ❑ 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____ _____Distancti from foundation---/P--------Ma tori al____ _(i� � f �_______- ®� No. of compartments__________________Size_�a--X--7 --•-__Liquid depth____- _�______,Capacity__ Disposal Field: Distance from nearest well---- Distance from foundation....� ----------Distance to nearest lot line--4......... ® 11— Number of lines________.-._ /� Length of each line__ Q.�-/�-______..Width of trench-----Ak �___.______--:- � Type of filter matenal__��lCO'Depth of filter material_/f____________Total length_____ _ fl_--------------------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_.____________.-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------- ----Depth-------------.---•--------------- Cesspool: Distance from nis ra est-well--� - —Distance from--foundation_------------------- Lining material_------------------------------------- Size: Diameter------- ------------------------------Depth----___.-_.-____.____________-__2-—"__________Liquid Capacity gals. Privy: Distance from nearest well-----------_-------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------------------------------------------------------------------ ----------------------- -------•--•-------------------- Remodeling and/or repairing (describe):------" ---'-"-= ------------------------------------------------------ ---------------------------------------------------------------------------•----------------------------------•----------•---------------------------------------------- -------------------------------------- ------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------'-------------------------------------------------- -------------- 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. r d (Signed) r Contractor g • Titl --------- ---------- y•-------------------------------------- --------------------- ( 81 n�l/ (Plot plan, showing size of lot, location of sys in relation to wells, buildings, eefc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_ _c �.-' ---------------------- -- ---------------------------------------- DATE--------, -0---- ----------------- � REVIEWEDBY-------------------------------------------- ------------------------ ----------------------------------------------------- DATE---------------------------------------------------------- M BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------- Alterations and/or recommendations:------- ------ ---------------------------------------•-•--------------------------------------------------- ;-------------------------------------------- I -------------------------------•-----------------------------•-------------------------------------------------------------------------------------------------------- --------------------------------- -------------------- --------------`----------------- ------------------------------- -- -------------------------------------------------------------------------------------------------------•-- -------------------------------------------- -------------------------------------------------------- --- ---------- ------- ------ --•--------------------------------------------------------------------------------------------------------------- y �� %v FINAL INSPEC -- ---- - Date---- - � � SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 300'West Oak Streot 132 Sycamore Street �y r 814 North "C" Street ` Stockton, California Lodi, California �7. Mantecas California t' Tracy, California ES-9-2M Revisod 8-'59 F.F.Co. J