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` APPLICATION FOR SANITATION PERMIT Permit No. .-1_ __ �� 114/1�� 0 (Complete in Duplicate) y� /d•'�!J This Permit Expires ] Year From Date Issued Date Issued ______/_____.__.__ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work rein escribe This application is made in compliance with County Ordinance No 549. 173 — I2Z~-1,4, T �/ ?'2--2 t '��( S� qq r _ / I JOB ADDRESS AN CA N.-J �= Ct� ......ow ..4C 1 -------------- Owner's Name. p --------- --------- ---------------- - Phone Address ----•-------• -- .--- �Q. _� - -- ---------•----------------------------------••----------------------------------- Contractor's Name --- •----------------------------- -------------------------------------•---------------------- Phone----------------------_-----•---- Installation will serve: Residence gr'-A-partment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms -An- Number of baths -_/___ Lot size .7p-X-__7J_-__-__•._•________________________ Water Supply: Public system 0--c-ommunity system ❑ Private ❑ Depth to Water Table __y&Fft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay © 1d'Ibe` Hardpan ❑ Previous Application Made: Yes ❑ No ®r New Construction: Yes W?'�No ❑ FHA/VA: Yes No W- ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic>k: Distance from nearest well _ _____Dis}ante_ rom foundation____Z4?--------Material__. - ----------------- ,J No. of compartments__.__- .__Size_*4 _X4449.-------Liquid depth-_._' _ ----------Capacity---OL/Q___---- Disposal Field: Distance from nearest well----_--------Distance from foundation____10--------- Distance to nearest lot line---J--___•__Number of lanes_________ ____r.____.-_____ _ Length of each line-------9Q_`-__---_------Width of trench----#2-7 _.___________________ Type of filter.m ---- � ;F'!,k-Depth of filter material____ ___________Total length------- 6 s Seepage Pit: Distance to�n$arest well______""4_______Distance from foundation____--l�_s_.___-Distance to nearest lot line__-___-_ � .33 Number of-pits________________Lining material__/l�Pfr___�____5ize: Diameter__________ _____-____Depth___ -_______...___-._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-___________--_-----______-._________. ❑ Size: Diameter.____-------------------------Depth--=-------t------------.-------------------------LiquidSCapacity----------------------------gals, Privy: -Size: from nearest well_-------------------------------------------------Distance from nearest building___________-_______________._____.____. ❑ Distance to nearest lot line- --- -------------------------------- ------------------------------- ----------------f-;-------------------------•--•------------------- --"& •�'� -----------•---- -----•---•------------- Remodeling and/or repairing (describe):______....__.__ _ ;-__-- - --------------------------- --------------------------------------------------••---------------------------------------------------•--------------------------------------:-------------------------------------------- ------------------------------ s ________________________ _____._____-___S___________________--------------------.---.-------- 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} / --- ---/---- ---- ---------------------------- ----------- ----------- (�or Contractor) gY ----------------------------------------------------------------- ------�'llT�� -----------------------(Title) { P121�/' (Plot plan, showing size of lot, location of sysfe n relation to wells, buildings, etc., can be placed on reverse side).' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- -- DATE_--------r- -------- --------------------- REVIEWED BY - DATE CI ' --- ----- ---------------------- ------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- Alterationsand/or recommendations-------- -- ----------------------------------------- ------------------------------------- ------------------- ----------------------------------------------- -------•--------------------- --------------•- - - -- ---------------•-------------------------------•------------------------------------------------------•-- f ------------------- 'IV ! ----------------------------------- ------ ----------- ---------------------•-------------- --------------------------------- ----•-------------------------------------------------------------------------------------- FINAL INSPECTION BY:.---- ---------- ---------- Date---------- .- ----A- ------- ---- --- ----------------- 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-92M Revised 8-'59 F.P.Co.