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1 APPLICATION FOR SANITATION PERMIT Permit No.......... r fi (Complete in Duplicate)Date Issued ___ � This Permit Ex ires 1 Year From Date Issued G. 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. p7 Z _ 0 2,0_ 0 �y JOB ADDRESS AND LOC TION r---------- = I� �3 - _'4�% - Id? /l J. _ _ �f/1`e----- Owner's Phone Name-------- /�. ,l -J fA - _•_ ------ -- --- = __ -------------- Phone------------•--------------•---•-- Address. .A •• <.1.{1Ad---------------------------------------- --------------------------------------------------------------------- Contractor's Name p {J. Q :r- ----------- I—— Phone__ ............... n Installation will serve: Residence Apartment House ]] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms Number of baths-__- Lot size __. f' - ------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft. Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2'--H'ardpan ❑ Previous Application Made: Yes ❑ No [ ' New Construction: Yes R-INo ❑ FHA/VA: Yes g?"Vo ❑ 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 _".._"`___-Distance rom foundation ----- AP------ Material__&,_i-" e •� fl` No, of`compartments ------- A- ------------- Size_,-_X_V0'--------- L':qui.d depth ----- 4�`!R------- Capacity -/r N Disposal Field: Distance from neares well--_ '^.:.__Distance from foundatio ___...-.Disfiance to nearest lot line_-�_�_-. p �j Number of lines ___--- j-_-_. --_._ _____ Length of each line-____ ��-- � __._.Width of trench_._._ Type of filter materialZX kxt Depth of filter material_f, �/ Total length ------ -------------------- Seepage ------_-_--•_.iSeepage Pit: Distance to nearest well_______________ _______Distance from foundation -------------------- Distance to nearest lot line _______._______ ❑ Number of pits ------------- -------Lining material ---------- ------------Size:: Diameter ._.--------------------- Dept h---- --------------------------- Cesspool: Distance.from nearest well ----------------- Distance from foundation..._ -___._.---.___.Lining material ------------------------------------- E ❑ Size: Diameter-------------------------------------- Depth ----------------------- -.`-=-- -- = ------ Liquid Capacity ---------------------------- gals, I Privy: Distance from nearest well ------- -----------------------------------------Distance from nearest building ---------- F1 -------❑ Distance to nearest lot line ------------------------- ------ Remodeling and/or repairing (describe):_-- "----- --- 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) 9 ] f+4� �✓ - -� -tri r.' ------- ------------------- ------------------------ Por Contractor] I ov;8Y• �-s r• -----------------------------------(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 ONLYAM APPLICATION ACCEPTED BYii.�-- ----- -------------- DATE -I 1 �C ---------------- REVIEWED BY. ------- DATE BUILDING PERMIT ISSUED------ ------------------------------------------------ ----------------------- DATE.------------ - ------------------ -----------_._------------- Alterations and/or recommendations: _.--:-_ _- ---- --------- N �_�... = - °---- --- � -------- -------------------------------- --- ------------------------------------------------------------------------- FINAL INSPECTI - - ------ ---------- Date--------- f ---15 r, CD 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 ES -9-2N4 Revised 8-'59 F.P.Co.