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if APPLICATION FOR SANITATION PERMIT Permit No. ../-_/_--t._/...._ (Complete in Duplicate) Date Issued IAO This Permit Expires 1 Year From Date Issued 1- 7 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 Ordinanc;p No. 549. �_f JOB ADDRESS AWa OCATION ----- ---L�?!�Gll .�2� - ----- ------------^-----�-------- ------------------------- ------------------------- Owner's Name t • ---------- Phone Address-- ©� �.- ��%ts� . r"PG� Contractor's Name__________, ._L. �_.___ .�;, 'y----- Phone Ut' � ___. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f---[� �,/ i Number of living units: _ _ Number of bedrooms - . Number of baths ----`-- Lot size __ ___X.� O------------------------ Water Supply: Public system ❑ Community system ❑ Private Ro"bepth to Water Table-_'�__Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe 2--lHardpan ❑ Previous Application Made: Yes ❑ No 2-----New Construction: Yes ❑ No [P---FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fe'et.1 ` n,(c: Distance from nearest well------------------Distance from foundation....................Material-------------------------------------------------- iNo. of compartments--------------------------Size--------------------------------Liquid depth-------------- -----------Capacity----------------------- Disposa Field: Distance from nearest well________________ Distance from foundation--------------------Distance to nearest lot line................. ❑ 4Alumber of lines__________________________________Length of each line------------------------------Width of trench_____________,___.-________________ Type of filter material-____--------------------Depth of filter material----------------------- ot Tal length_____.__________ _____ ____________________ �_-y , Seepage Pit: Distance to nearest well- ,OO---______Distance f om f undation 1.49_ Distance to nearest lot line __-___ Number of pits------/------------Lining material. ---.Size: Diameter----y$---- Depth _cr�-r ----- Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material________________-__________-_________- ❑ Size: Diameter--------------------------------------Depth------------------------------- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- 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, St laws, and rules and regulations of +he San J quin Local Health District. V (Signed) �"1 / - --------- Owner and/or Contractor) BY� -• ---- ---=----(Title)-- i --------------- .. -- ------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY--------- - -------------------------------------------- DATE.....r " �y�= ----------------------- - - --- -- - --------------------- REVIEWED BY - --------------------- ----- •---------------------------- DATE--------------------------------------- . ................ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------------------------- Alterationsand/or re mmendations-----------------�-------- ------------------- ----------------------------------------------------------------------------- -------------------------- ----- --------------------'- ----------------------------- -- --------------•----------------------------------------------------------- ----- - _rr` ---------------------------------------------------------------• ------------------------- =�j - -- -------------------------- ...--- ----- ---------- --------------------- le!FINAL INSPECTION BY.. + Date ----------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRIG 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.