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FUKUFF l �l ------------- APPLICATION FOR / SANITATION PERMIT Permit No. ..l..�.vt�....__. ----------------- (Complete in Duplicate) 1 l' -------------------------------- -------------------- --- 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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN4 LOC TION_ 57 r Owner's Name---- Ph Address.1,,30..• ------- -----•-- . Contractor's Name. � --------•-----------------------------•------------- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ --� ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __j__:_ Number of bedrooms -?--- Number of baths ---/... Lot size -_-I_"11 .,A..... Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table _ 1d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jp Hardpan ❑ Previous Application Made: (If yes,date------ -------------) No G New Construction: Yes k No ❑ FHA/VA: Yes ❑ Nop TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feetf) Septic Tank: Distance from nearest well__-_--�_. ,_histance from foundation-----_Acaterial------- No. of compartments_. " X_-_ Size_ -- -- Liquid depth S Capacity--- Disposal Field: Distance from nearest well----j_ .3 stance from foundation-__l°r Distance to nearest lot line__.. !0-9? Number of lines-------1-t-------- _._ Length of each Iine�;,�S� J'�#�/idth of trench___` _________________ Type of filter material-- - - -- ---------Depth of filter material___ .,r,�u_.--Total length-__-. .,>- --------_------ w Seepage Pit: Distance to nearest well_._) Distance fro fou ation_...�QDis ante to nearest to line �rll,( Number of pits________ ________Lining material__-____ _ ____Size: Diameter__17_1 __ ______Depth...... 3- esspool: •Distance from nearest well----------------- from foundation--------------------Lining material__.____-__-_-____-_-_-.___-___---_-_ ❑ Size: Diameter-------------------------------------------------•-------------Depth----------------------------------------------------Liquid Capacity-----•-------•---•---•------gals. Privy: Distance from nearest well---------------.---------------------------------Distance from nearest building ❑ Distance to nearest lot line______.__ Remodeling and/or repairing (describe):--/ 44,0_,&4 ----------------------------------------------------- -----------------------•-------------------------------------------- --•--- •--------------------------------------------------------••-------------•------------------------•----------------------------------------------------•---•--•---------------•----------------- ----- ---------------------- -----------------------------•-------------------------•--------------------------------------------------------------•---------------•----------------------------------------- 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, an" rules and regulations of the San Joaquin Local Health District. (Signed)----- 1 _Ca2,2 ------------ --------------------- ----------------- ----------------------------------------------_(Owner and/or Contractor) - By:--------------------------------------------------------------- ------------------------------------------------------------------(Title)---------------------------- ----------- --- - -------------- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O Y APPLICATION ACCEPTED BY--__. s.... C�Z� r DATE ---- --- REVIE1h/ED BY-------------------------------------------------------- ------- ---------- ------------------------------ --------------------------- DATE ---- ------- ---- BUILDING PERMIT ISSUED---------------------------------- ------------------------------------ DATE ----------------------------- Alterations and/or recommendations__________________________________________________ FINAL INSPECTION BY:------- Date . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 8-59 F.P.0 O.2M 6.60