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3f�U x, APPLICATION FOR SANITATION PERMIT Permit No. .. Y {Q � (Complete in Duplicate) Yw This Permit Expires I 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 herein ZSCribled. This application is made in compliance 30 l�iJ- Y4slfc€ j wn+ith.�C,'� ounty Ord' ante No. 549. . r Pho-ne �/yiy{cad,cad,�JOB ADDRESS AND LOCATIO --- L � Owner's Name-----------------------�....... erp Address----------------------------------------f11 _h.t'-1`l!, ---------------- ------------------------------------ - ------------ Contractor's Name ..'.. r f� ---•-----. Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court [j Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms .3- Number of aths _ _ _ Lot size ---- ___________________________ Water Supply: Public system ❑ Community system E] Private Depth to Water Table 647 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: Yes E--I�o ❑ FHA/VA: Yes ❑ -'No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.t Septic T Distance from nearest well W_thLX!Distance from foundation___��")_� __.Material___-- Q_Y'__- �' .' 02 No. of compartments_.__..-_-;Z.....,.__Size___�---------------------_---Liquid depth.?____-..___.._________Capacity----$BC7_ r Disposa Field: Distance from neares well_! DVMIO-Distance from foundationfQ-tt��'-Distance to nearest lot Number of lines------ ------------------------Length of each line------*7 -----------------Width of french-___ } l Type of filter material_-_�-- 0_C- Depth of filter material------ __.-__Total length_----_.-- Seepage Pit: Distance to nearest well-____________________Distance from foundation--------------------Distance to nearest lot line_____.._______.__ ❑ Number of pits----------------------Lining„material-----------------------Size: Diameter-------------- --------Depth--------------------------------- O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- •1 [] Size: Diameter--------------------------------------Depth-------------------------------- - ------ -- -- Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------- from nearest building-_-------------------------------- ❑ Distance to nearest lot Jine----------------------------------------------------------------------- ---------------------------- ------------------------------ T I 1 Remodeling and/or repairing (describe):------------- -_ _ ------ --- __��__--____ a --------------------------•----•----------------------------------------------------------------------------------------------------- ----------:.-------------------------------------------------------------- ------- ------------------------------------- -----------------••-•------------------------------------------------------------------------------------- -•-------------------------------------------------------------------------- -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- �. a. h hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a081nances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)._ :-----63 '-------------------------------------------------------------------------------(Owner and/or Contractor) -----------------------------------------------------------------------------------------------------------------------------------(Title)-------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------------------------- ---- --------------------------------------- DATE--------------- -� REVIEWED BY----------------------- �- ,- -- --- DATE----- - ---- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE --------------------------- Alterations and/or reco m ndatigas'----------------- ---------- ------------------------------------------------------------------•---------------------------------•--------------------------- ----------------------- -------------------------- •-•-------------------------------------------------------------•---------------•------------------•------------------------------------------------------------------- -------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- FINAL INSPECTION BY:. -- ----------- Date------ ?. 7� ------------- 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.