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APPLICATION FOR SANITATION PERMIT Permit No. ...��.�t�.. . (Complete in Duplicate) Date Issued .... This Per Expires 1 Year From Date 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. n JOB ADDRESS AND LOCATIO „'-- -'�--�---------�/+ - 4 ' (AE 1 !.�� .c_=/. 'I Owner's Name ---- d , d_�C..t---------�_�� ----------- ------------------------------ Phone_ _Z?__Z•;9-7 Address Aq Contractor's Name ----•--•---------•----•-----------•---•---------------- •-------- •-•------_- Phone................................... Installation will serve: Residence` Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---.. Number of bedrooms ___"`Number of baths _/____ Lot size .___._______- "- Water Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: YeiVE No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we(J.. c 6 -__Distance from foundation_.... _._._.Mate i I `__ -- T_.. No. of compartments -------------------Size.. �. p �r _ .?._..Li uid depth__________ -------------- _ _ _Ca acct Disposal Field: Distance from nearest well _..._Distance from foundation.._ G�...__Distance to nearest lot line_.. '� J rl Number of lines._____..__,2 __________________Length of each line-4.0________-__ _ Width of trench.--------_ 4e c Type of filter material__.1 ----Depth of filter material-------- ___ _ _ Total length-------------------- -• Seepage Pit: Distance to nearest well----75----------Distance from Distancefoundation,__.1549-------- to nearest Lot line--_-Jr� — ❑ Number of pits--_-f___--_---__Lining material__ AGI!� '--Size: Diameter------5.. _______Depth- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-_--.-_----_--.---____.-_--_---___. ❑ Size: Diameter--------------------------------------Depth----------------------- ---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------.__.--_--.-. ❑ Distance to nearest lot line---------------------------------------------------------------•------ Remodeling and/or repairing (describe) 1��11' GEt ---- - ----- l......-----•.. F—B ------------•------------•------------------------------------•----------------•-------------------------------------------------------------------------4. --=------- Q=•---•------•--------------------- ------------------------- ---------------------------------•---------------------------------------•----------------•---------------.------------.-------------------------.--------------.----------------.-------------- - I hereby certify that I have prepared this application and that the work will be dope in accordance with San Joaquin County ordinances, State laws, and rules and regulalions of t e San Joaquin Local Health District. n (Signed)-Z...-,i`-v ` -< r Zt-1 ----------------------------------------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells,4suildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ` -'1 ----------- REVIEWEDBY -- ----- - f --------------------------------------------------- DATE------------------ -------- BUILDING PERMIT ISSUED------------------------------ ----------- -------------------------------- ----------------- DATE----- Alterations anti/or.recommendations:---•------------------------------------------------------------------------------------------------------------------------------- --------------- ------ ---------- ----- --------------- _ �' ----- ---.ALT t ------- - � �` ---- --------- - ---------� ---�" --- --------------- -----------•---------- --- ----- - --------------- - ---- ---- ..........----.....- ; FINAL INSP --- - Date------//---- 4._. 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.