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6 o Ccs APPLICATION FOR SANITATION PERMIT Permit No. G' (Complete in Duplicate) / r�l S_. 0 This Permit Expires 1 Year From Date Issued Date Issued -------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work m d cri ed. This application is made in compliance with County O an�4UZ2- Owner's No. 549 J� JOB ADDRESS AND42T ON. 11�F-. --Name------------> _--, �!larZ --"------------------------- ----------------------- --------------------- Phone-------- -------- Address----------- .:. Contractor's Name - 1 . Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _u?_. Number of baths Z--- Lot size_.. teC/'___'------------------------_---• Water Supply: Public system ❑ Community system ❑ Private RT"Depth to Water Tablets'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe?T**`Hardpan ❑ Previous Application Made: Yes ❑ No g?"'New Construction: Yes Ra-`rlo ❑ FHA/VA: Yes R?'-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest wel /44____Distance from foundat -- 4 uj-------- No. of compartments_--- j---.---_-Size.�-lFl � rYPLIquid depth 1. --XZt-�---� _ c �, Disposal ield: Distance from nearat well_1101eZ__Distance from foundation..e4 .......Distance to nearest lot line..h1__�__.. Number of lines___. "` Length of each line----- _ `- -------Width of trench.--�------------._-_----.Is J Type of filter material..t� _ __fesDepth of filter material___,�e��`_-__-_Total length------ „ _________________ Seepage Pit Distance to nearest well__/_X_e .__Distance fr��QQm foundation__J.P._..__..Dista..Distance to nearest lot line_.a, ....___ Number of pits----- -___-Lining mate nal__d �� __Size: Diameter__: _ ___-__..Depth__ s�`~_`_--.__--_____Cesspool: Distance from nearest well__-_._-__-____Distance from foundation______-_--__-_-_.Lining material.______ ______________________ ❑ Size: Diameter------ ------------------------------Depth----------------------------------------------------Liquid Capacity--------------_--------•--ga Privy: Distance from nearest well _-.-_- _-.- Distance from nearest building------------------------------------------ FI _-_________ ___________________________❑ Distance to nearest lot line- ----- -- - i ---------------------- Remodeling -- ----- = - Remodeling and/or repairing (describa)._____ r ._ .__ --------•---•_------•---•--------------._•__•--_---------•-----------•----•--------------------------------------•-------.----..._._....._. ----------------------------------------------------,__...-____--._.___----_-__.--------------------------------------------------------------------------.------------------------------------.---__--____________-.-_____ I hereby certify that I have`prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health District. Signed . ' --- -- -- - ( oF Contractor) ( 9 ) .- - - ------ --------- -- - - BY: -------•----------------(Title - - - - ---- --------- (Plot plan, showing size'-of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------------------------------------------- DATE..---` 5� - --------------------- REVIEWEDBY-------------------------------------------- -------- -------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ------------------ DATE------ ----------------------------------------------------- Alterations and/or recommendations------------------------------------------------ ------------------------------------------------------------------------------------------------------------ ------------------------------------ ------------------•--------------- ------------------------------------------------------------------------------------.------------------------------------------------------------ -------T - -_._-------•---- _.__.____. _____...__-..______._..___..________ __ _________________ 71--__-___________- y . __� --------------------------------------------------------- ------ 5 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 P:P.Co.