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( ` APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) V! 1 This Permit Expires 1 Year From Date Issued Date Issued __..1_____` I-V 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 LO ATIONF2- q 1 �!= �_.} -------------- Owner's Name______________ - ��u aa- ' -----`-�---------------•__---- -------------------4 ------ Phone-------------------................ Address......................................... ----------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name ---�----------------------------------------------------------- ----------- Phone................................... Installation will serve: Residence� Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other [] Number of living units: I--- Number of bedroomsC3-._ Number of baths __L_'Lof size ___.-_,::___ ---x---- Water Supply: Public system ❑ Community system ❑ Private jM- Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,g[ Hardpan ❑ Previous Application Made: Yes [I No [g New Construction: Yes ❑ No FHA/VA: Yes,& No ❑ TYPE OF INSTALLATION AND SPECfFICATIONS: adwA' '_K (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �s Septic Tank: Distance from nearest well_!$� -------Distance from foundation_.../0 ,___.Material+.S_OCB _.._. No. of compartments------.�_�__ ------------Size.... __9 $_,___Liquid depth._- �-- _Capacity___ �_�i Disposal Field: Distance from nearest well_ _-.--Distance from foundation.__.__ a..__...Distance to nearest lot line Number of lines----- Length of each line *.Width of trench._.__... _ f __________ jnType of filter material----- d - ,„ _____�..._.-.__.-_” Seepage Pit: DistarW_ejto nearest well----------------------Distance from foundation....................Distance to nearest lot line-_-__---______-__ ❑ Number of pits----------------------Lining material_______________________Size: Diameter---______---_c__......Depth------------------------......... Cesspool: Distance from nearest well------- .,._ __Distance from foundation--------------------Lining material------------_______-_-____________ f ❑ 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):--------------------------------------------------------------------------------------------------------------------------------------•----------------- -•-------------------------------------------------------------------------------------------------------------•-•-----•-•------------------------------•-----------•-------------•----- ------•- ------ -- - ---------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Wte laws, and )rules and regulations of the San Joaquin Local Health District. (Signed)-----(11��_r_.14L -- - - ------- ------------------------------------------------------------•------------------------------.Owner and/or Contractor By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------- -•----------- ------------- -- - ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- -- -- ----------------------------------------- DATE REVIEWED BY----------- - -- ------ ---------------------------------------------- DATE - A-��---- BUILDINGPERMIT ISSUED------------------------------------- -• ------------------------------------------------------------ DATE------------------------------------------------------------ Aiterations and/or recommendations:-_.-- W&5w"____Z-HT_IQIVr_...__t�1!�_-_l�_e4�________UsLj-____ -------- -'.____________ ------------- ---------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ----------------- -- •--------------- --- ----- ---- --------------- -- _ • -------------••------------- .................................................... ........................... ------------------------------------------ ---- ------- -- --------- ----- - - ------- ------- - - ------------------------------------------------------------------------------------------------------J-------- FINAL INSPECTI -- -- -- - ----- ------------ -------- -- -- - - ------- Date--------- il SAN Z� 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.