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#` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ._..._.Y:?::This Permit Ex ires 1 Year From Date Issued zz —0..30—0 6 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 ANDLbCATl6k_._W Owner's Name � -------------7---,�1.1c111,�--------------------------------------------------- Phone------------------------------------ Address---------------------------------------------------------------------A4 cam. ----------------------------------------------•--- I Contractor's Name----------------------------------- ---------'� ---•-------------'------ Phone---------------------------------- - Installation will serve: Residence ue,Apartment House❑ Commercial ❑ Trailer Court ❑IMotel ❑ Other : � a Number of living units: __/___ Number of bedrooms4 3--• Number of baths __ Lot size�_ __ ___------..�` _______________________Of I ¢ Water Supply: Public system ❑ Community system L] Private F] Depth to Water Table -f.""# 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpub�ic sewer is_available within 200.feet.� � �- Septic Tank: Distance from nearest we4_5 '+once from foundation__ _ later�l__ - -►-- -- =- �] No. of compartments______ ____.._____..Size_ _ _.__.Liquid depth------- :_. ---------Capacity-Capacity-�� r� Disposal Field: Distance from nearest well___ _� stance fr6m-fouYdation_ .67-1., -Distance'to nearest lot line.... ® Number of lines------3__-_- .___ _ 'Length of each -line--------- __ ii Width of trench___.. _?L-�� ______.____ �! Type of filter material____ _ . . - epth of filter material-. 49------____Total length----------.__>�-----__________-- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------ to nearest lot line_______._______._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____------.-------Lining material-------------------.________________- I ❑ Size: Diameter------------------ -------- ----------Depth--------------------------------------------------._Liquid Capacity-------------------------_-gals. Privy: Distance from nearest well_______________ I�_______---.---_-__--_-_____Distance from nearest building------- --------------------------------:_. ❑ Distance to nearest lot line--------------------------------------------------_------------------ Remodeling and/or repairing (describe:__[ __ _--r+ _ --____-_--_�L.-.� ^� -----� -•--- `'ar. - --- � � `` '- - - -- ------------------------------------ � I --------------------------------------- - - - -------------------------------------------------------•- -------------•---------------------------------------------------------- ---- --------------------- ----------------- hereby Certify at I ve prepared this application and that the work will be done in accordance with San Joaquin - uin Count ordinances, State la s, an rules and a ns the San Joaquin Local Health District. I (Signed)------------ ----- ---- ---- ----- ------------------------- Owner and/or Contractor ( / )� BY: : 1. ------------------------ -- ---------------- -----------------------------------------(Title) (Plot plan, showi S" of lot, location of sys+em in elation to wells; buildings', etc,came placed on reverss d). F E USE 9ILY •` APPLICATION ACCEPTED BY--------- --,____-- _-- ----- am -- ----- -------------------------------------------- -- •Q---------------------- REVIEWEDBY----------------------- -------------------------- ------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------•--------------------. DA-TE------------------------------------ - --------------------- r, Alterations and/or recommendations----------- -----------------------------------------------------------•------------------•----•------------------------------•------------------------------. i� ' ---•---------------------------------------------------------•-------------------------------------------------------------------------------------------------------••-------------------------------------••---------------- - --------- ---------------------- --------------------••-------------------- ----------------------•---•--------------------- ---------------------------------------------------- •------------•------------ --------;--------------------------------------------------------------•-- ---------------------------------------------•--------------------------------------------------------------------------------------------------- --------------- f 1=1NAL INSPECTION BY:.. ------ Date--- SAN ate--SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.