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APPLICATION FOR SANITATION PERMIT Permit No. . Lr ./.-.. (Complete in Duplicate) 7 Date Issued This Permit Expires l Year From Date Issued ._ _ ..- O S��'o Application is hereby made to the San Joaquin Local Health District for a permit to construct and installfthe Wri herein described. This-application is made,incompliance,with County Ordinance No. 549. c,--,ate >� (� ------ d�---f--AJOB ADDRESS AND LOCATION---------------------- 74 __-' - - `------ Phone_.�Owner's Name------- h-- ------------- Address ----------- Address------ -- ZL�.941.!'/------------`1!_jC--- Contractor's -Contractor's Name --OL-------� � �--- -- t= -- -20;"r'c— --------------•---•-- ----- Phone..��_�.7..�__`7* Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other Number of living units: - Number of bedrooms --------- Number of baths- Lot size -------- J- J________________ Water Supply: Public system ❑ Community system ❑ Frivate,4 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam 11'�& Clay Loam Clay [] Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑• No(�New Construction: Yes,72�'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 244 feet.) Septic Tank: Distance from nearest well__,rQ------Distance from foundation ------Material----e- ___ ` _______________ c No. of compartments____ __________________Size_,51W/_`,a -:___Liquid depth_• 0.____..______.-Cap acity_/�o�_ -A- ` Disposal Field: Distance from near st well_ d__._Distance trom of unclation--__ � _p_ __.Distance to nearest lot line------h:.. � Number of lines___ Length of each line_f t_'Ya_'__-�-`.Width of trench------ -` _'!_____________ - -------- ---------------- - Type of filter material___- __1X11�_----Depth of filter material____1__ -------Total length--------S__A_6?--------------------- p g }; See a e Pit: Distance to nearest well------_---------------Distance from foundation-------------------.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------------.---Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- n Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity- .-----------------------gals.k' Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line------------------------------ -----------------------------------------•----------------------------------------------------------r-------- Z Remodeling and/or repairing (describ )------ti_______________ �} !!ll�G�-- - -�, -- i -t,�.�� --- ----------- ---- ------------------------------------ o --------- ��- ------- ------ ------------------------------------------------=------------ -------------------------------------------------------- -------------------------------------- ------------------------------------------ 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 regulatio s of the San aquin Lo I Health District. 1 --—— ----- --- -------------------- (Signed) f►s Contractor] gY - - --------- (Title) (Plo+ plan, showing size of lot, location of sys in relation to wefit, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------------------------------------------ DATE----------T ''r �� -------------------- ----- ------------------- REVIEWED BY - -- ------------ DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------- --------------- Alterationsand/or recommendations:----------------------------- -------------------•---•-------------------------------------------••----------••-------------•-••----•------•------------------- -- -------------------------- -----------------------------------•---------------------------------------------•---------------------------------------•---•---•----------------------------------------------- ----------------------------------------------------- ----------------------- - -----------------•----------------------------------------------------------------------------------------------------------------------- Z""i FINAL INSPECTION BY:_. ` 1 ------------------ Date.---�1...~_��_ ��- 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 6-'59 F.P.Co.