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APPLICATION FOR SANITATION PERMIT Permit N;. :j ../.!.. . (Complete in Duplicate) # This Permit Ex ires 1 Year From Date Issued bate 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. JOB ADDRESS AND LOCATION--.----6-2--�- 1'-Z -.-___, _____ ____ ___ ---------------- Owner'sName----------- - =----------------------------------------- Phone-----------------------•------------ Addrass------------------- ��..•_c'►--. -------------------------------------- Contractor's ------------------------------------Contractor's Name-------••------------------ - ------------- Phone_ Installation will serve: Residence [YApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: --/--- Number of bedrooms - _ Number of baths -/-- Lot size _-- 'Q_-1 ------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table..-5-7�ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe � rdpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No �%/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: #No septic tank or cesspool permitted if public sewer is available within 200 feet.) n Distance from nearest well------ - --------Distance from foundation-----------_-------.Material--___.-____--------- _-------------...___--__.No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------- F-�eld: Distance from nearest well. - Distance from foundation-lG-----------Distance to nearest lot line.,-c--.--_-- Number of lines__--_____--/--------------------Length of each line----_Via--/---.-----_-_Width of trench-----?_�le----------------_-_ Type of filter material-lf --__-_- ._- opth of filter material-_'2- -___---Total length-----.tea---------------------------- --y, J Seepage Pit: Distance to nearest welt__/ __ Distant m f undation__,,lQ_____-_.Dis#ante to nearest lot line----------------- Number _S-_____-_.._ Number of its-.-.---- _-----------Linin material_` Size: Diameter._.-- ....l_-_.Depth---,:;Z--5 i Cesspool: Distance from nearest well-_--------------Distance from foundation--------------------Lining material---....------_-----.--.-------------. ❑ Size: Diameter---------------------------------- -- De th---------------------- ----------------------------Liquid Capacity----------------- - -----gals. Privy: Distance from nearest wel€--------------------------------------------------Distance from nearest building_-_____--------------___--__-_-.--------. ❑ Distanceto nearest lot line--------------------------------------------- Remodeling and/or repairing (describe):----- Q/1 ...k ------ ----------------------------------------------------- --------------------------------------- ----------- Y -----------------------------•--------- --------- -------------=--- -------------•---•---- ---------------------------------------------------------------------------------------- - --- C,wii�i , - -- --------------- - �._ �� - ---------------------- I hereby certify that I have pre tired this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- -- --------------- ------ ------------ ----------------------------------------------------- -(Owner and/or Contractor) Y•-----------•----------•---------------------- -- - ------ ---- ------ -- B (Title) r (Piot plan, showing size of lot, location of system in relat to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---------------------------- DATE--- REVIEWEDBY--------------------------------------------- ----- ---------------------------------------- --------------------------------- DATE---•-- •-------------------------------- t BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------•----------•-----------------•--------------------- Alterations and/or recommendations--=------------ --------------------------------------------------------------------- ----------------------------------------- '+ ---------------------------------------------- ----------- ------------- - - �Z=2 .�1 / --- ----------- ------------ ---------- ----------------------------------------- --------- ---------------- ------------------------, r L -�-- - ; t ---- --------------- ---------------------------- -- ------------- - "�¢ ` � �' ,�c. �r�ce�a FINAL INSPECTION BY:( ...�_�. Date---- 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.9-2M Revised 8-'59 F.P.Co.