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II I APPLICATION FOR SANITATION PERMIT Permit No. ...43 f-O ( ) p p (Complete in Duplicate) 3� J I This Permit Expires 1'Year From Date IssuedDate 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. � Cff D4JOB ADDRESS AND LOCATION- ------------------------------ ------------- _. --�--G--+-�---1---z----"-�---[-f - I Owner's Name 1 Address------------------------------------------------- - C? t e .:. -------- --------_------------------------------------ �l Contractor's Name--------------------------------------------- `----------------------------------------------------------- ---------------- Phone..__....__------------••---•------- r Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: I____ Number of bedrooms A... Number of baths ----Z Lot size ___________ ___________________ ------------------------- W, afer ________________________Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamjX Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes E] No 5 New Constructio: Yes,kL No Ig FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 01 'fie (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Il Septic Tank: Distance from nearest well_ U..__.__Distant from founclation__.___/f�_____.Ma/t�'isi__ ___ ____-_____________ ___________________ No. of compartments_.___--------------Size..---- _k Liquid depth------T_------._.....Capacity....tl ..--- n isposal Field: Distance nearest �ell... --Distance fro.m founclation.,_ �d_______-Distance to nearest lot Number of lines Length of each line________ro_,D-__--_____._.Width of trench._.__, _-______________ : Type of filter materialr44_!_1�'t��Depth of filter material----.__/ ---- --Total length-______._.l- C�------------------ I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-...____________- ( r it ❑ Number of pits----------------------Lining material----------------------Size: Diameter----•------------------.Depth--------------------------------- \ i1 l.) Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________._..--.---______.__________- �� ❑ 4 5ize: Diameter----- -------------------------------Depth----- C-=-------------------------------- --------Liquid Capacity------------------------- -gals. I i . _ _ p Privy: Distance from nearest well --------------------- __.____.__,,_ -- 1;----'I-----Distance from nearest building------------------------------------_._._. a ❑ Distance to nearest lot line----------- '- ------------------------` --------------------- ---•---------------------------------------------------------------- Remodeling and/or repairing (describe)=--------------------------------------------------e.------------------------ -----•-•----------•-------------------------------------------------------- Il ---------------•-------------------------------------- ----- ---------------------------- --•------------------------ I�,. IM " 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]• = - --- -------- -----------------------------------------------------------(Owner and/or Contractor) I By-------------------------------------- -----•------------------------_---------------------- ---------------------------------------(Tale)---------- ------------------------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). h i� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -= DATE REVIEWED BY----------------------------------------- -- ----- ---------------------------------------- ------------ - -- - -------------- DATE---------- BUILDINGPERMIT ISSUED----------------------- -------------------------........... ------ DATE--------------------------------------------- --------------- !Alterations.and/or recommendations:-------------------------- - ( --------------------•---------------•---------`� = ------------------ ----- �l ------ 4'` I� of i. ,iR '"----- ---------- --- ---------------------I------------ `� ------- --- -------------------------------------------- v - , a' ' ----!M ----- --------------------------------- - - ------ - - - --------- --------------- -f- FINAL -- _ ---- 11 t t.. sk ! VJ FINALINSPECTION BY--------- ----------------------------- --------------------- Date.----------------------------- --_------------------------------------------- SAN."JOAQUIN ------------------- SAN.JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street El Stockton, California Lodi, California Manteca, California Tracy, California f ES-9 2M Revised 6-'59 FY.Co.