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APPLICATION FOR SANITATION PERMIT Permit No. -_l"?,fj (Complete in Duplicate) f This Permit Expies l Year From Date Issued Date issued ---_ - � Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and 'ns#all the work herein described. This application is made ' compliance with County Ordinance No. 549. ,� � �� e JOB ADDRESS D OCATION----- --- ------ = -- --- +� -. - ' " f Owner's Name---- - -s. > C oC{ A-A vl < � .r i -- � �- t.-------- - ------------ /l Phone- Li 4& 4-7 Address �: . ----------- � �ra Contractor's Name---:g - ------------------------ ------- --------------------------•----- Phone---44--- Installation will serve Residence ❑ Apartment House E] Commercial [-] Trai[er Court E] Motel El Other EjCLnBoR 64m Number of live g-„6nits: -------- Number of bedrooms -------- Number-of baths -------- Lot size _____________________..----------------.-.---_.------.-.--_ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ._ _ ft. Character of soil to a depth of`3,,fiet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes Cj�K16 9 New Construction: Yes 10 No ❑'WrHA+/VA: Yes?® Nj'ON TYPE OF INSTALLATION AND SPECIFICATIONS: r {No septic tank or cesspool permitted if public sewer is available within 200r feet.} Septic Tank: Distance frorh�nearest we110 -Distance from foundation-�.f a_'-i--.-.Material----.R_D__Woe>�L)---..---.--. iid depth---��__........ -_.+Capaci#y 14-00.'7�-� p Number of lines.-_--- t - rL- th bf eac line_ ` Distance to nearest lot line-------------- Disposal Field: Distance from nearest well. �- �Dis anc!from ovndatio�n_�� -��.S��A/idth of trench---�-�-,��------------------ r~ [� 9 Type of filter material-- � -_ •epth f filter atelial-_4 -�f_"-______Total lengfih-_:4 �`?_�.-._- ------------- Seepage Pit: Distance to nearest well----------------------Disann� from bu-n 5tion-i-.-.. ":"Distance to nearest-iot-iine--.--------_----_j' ❑ Number of pits------.y- -------- ining.m�erial---�--------------------Size: Diameter------------------------Depth---.------.----------------------I, Cesspool: Distance from nearest well---__-___---_---Dis a n e from foundation--------------------Lining material---.--.-.___----_---.----_----.-----. ❑ Size: Diameter-- .... Depth Liquid Capacity gal T' Priv Distance from nearest well ------.-Distance from nearest building ❑Y 6 --------- ---------------------- -------------------------- ------------------•--•---- Distance to neaF�estlot line.----------------------------------------------- Remodeling and/or repairi6g,des" cribe�-------- -------------------------------------------------------•--------._-.------------------•------------------------------------------------------ff -----------------------------------=~ }'----------------------------------------------_----- ---- ------------------------------------�;--------------------------------•-------------------------------------------------------------•------------------------------------------------------------------------------- -. r --------- --------- ��--`--------------------•-----------•----------------------------------------------------------------------------------------------------•----------------------------------------------------- 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. I (Signed) a -- y? r9% Owner and/or Contractor) By: -Xis �---� - ---------- -(Ti le { )----------r------------------- ------------------ -------------- (Plot plan, showing size of lot,`location of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- _ ------••---•---•-------------------- DATE---- ---------------------- REVIEWEDBY -------- ---------------------------------------------- DATE-------------------•---•----------------------------------- I BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------- An .... ------------ ------------ ------•---------------------------”- ---- fit-------------•-----------------------r------ ----------------- - _ /A.!. __ ^"' ==j� ------- ' 4 - ----------------------------------------- ------------------------------------•---------------------------------•---------------------•--------- --------------------------------------------------------------------- ------- FINAL INSPECTION BY-------- -- ---------------------- - Date.----- — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Co.