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APPLICATION FOR SANITATION PERMIT Permit No. .J - �J (Complete in Duplicate) �3 Date Issued This Permit Expires 1 Year From Date Issued ... /_l9Ct Application is hereby made to the San Joaquin Local ealth District for a permit to construct and install t ork he i described. This application i-&made in FN e wit j�ount Hance No. 549. x' JOB 'A/DDRES "AND. AT - ZL - ---�, ------..... / ` • Owner's Name--------------------------- r�• +FJ6 -- ------ ------ Phone.................................... Address-------------------------------------------------p�--%Z-- ------ - - -- - -A--------- --,------r ------ - ------- ------••------------•------.................... Contractor's Name--------------------------------......................... ---------------------------------------------------- Phone--------.......................... Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms Number of baths _/-__ Lot size ___$_ _-_ _.___3! ........................ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth sof 3 feet: Sand EKGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No M�',F A/VA: Yj�s ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Q� (No septic tank or cesspool permitted if public;sewer is available within 200 feet.) ,,// _ Septic Tank: Distance from nearest well , 44/ istan a from foundation.11l_110?"' laterial------ No. of compartments--_-_--0-----------------SizeJrX__3_ -__"1--__--Liquid depth--_-_-' ---------------Capacity. .... Disposal Field: Distance from nearest from foundation/0_"w!"^+-Distance to nearest lot line___'!__ '---- O Width of trent __• r ---r Number of lines___.__+.___.____,_p- __Length of each line_______ ___________ _______ �-�•_. .___.j Type of filter material__,SI/_�__ Depth of filter material_____f$'-- ._____Total length___...... D____________________ Seepage Pit: Distance to nearest well___------------------Distance from foundation--------------------Distance to neare p4 ❑ Number of pits----------------------Lining material----------.------------Size: Diameter---------.-------------Depth_..____--.-_-_-__---_-__.__-_---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______-__--_.---____-__-____.-__-_. ❑ Size: Diameter--------------------------------------Depth-------------------- ----------------------------Liquid Capacity............................gals. Priv Distance from nearest well------------------------------------------------- from nearest building ______--_--_-_-.-. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------•-------- Remodelingand/or repairing (describe) L-*---------------------------------------------------------------------------------------------------------------------------------- --------------------------•---•----------------------•--------------------------------- ------------------------------------------------•-------------------------------------------------------------------------------- ---------------•-----------------------------------------------------------------------• _::------------------------------------------------------------------------------------------------------------------------------- -- -- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)-------------M --- t - �} ------------------- ------------------ (Owner and/or Contractor) /,, !'! (Plot plan, showing size of lot, location of system iv elation +o ells, buildings, etc., can be placed on reverse side).- FO RT T USE LY APPLICATION ACCEPTED BY------ ---` x ------ = -=-- DATE......��, Lei ' ------------------ REVIEWEDBY-------------------------------------------------------------------------------------------------------..................... DATE------..... ----------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------- ------------------------------------------------------------------•------------------------------•--•-••--••-----------•---------- �j ----------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ n --------- -- - ------------- -------- ------- - -- - -- ----------------------- - - ------------- - ---------------------------- ------ -- ----------------- FINAL -- - - --FINAL INSPECTION BY----------------- - e ---- Date------------1� - ��`f ----------------------------------- 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.