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APPLICATION FOR SANITATION PERMIT Q° Permit No. __� • ...- M (Complete in Duplicate) kDate Issued This Permit Expires 1 Year From Date Issued Application isereby 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 wi County Ordinance No. 549, JOB ADDRESS AND LOCATION- -Wil,,'-- - --- k;v 4- .�'/ � Owner's Name-------- __ __a -._- _ '='def —190 -1 , 1,' 'P._1? - ----- ----------- 4 - [' ----- � - - - Phone---�-----------------------•---- /�'rlllr6. � ll Address------------------- -- � � -3��--�-L�-•- ------� , ---- ---------- Contractor's Name----------------- l --------------------------------------------------- Phone---•------------------------------, Installation will serve: Residence j g�r Apartment House,[3 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin �g units: .-`-- Number of bedrooms`,, Number of baths_ 0_ Lot size ___ ----------------------------------- Water Supply: Public system ❑ Community system ❑ Private-20-Depth to Water Table c-04. Character of soil to a depth of 3.fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: Yes`❑ No ETO New Construction: Yes 22"No ❑ FHA/VA: Yes 2-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available w4hin 200 feet.) r Septic Tank: Distance from nearest w --- .....Distance from foundation- ,/, ------_-.Mat�rial /-_l.?-------. ? No. of compartments_____ ._.___.__._____ --Size__! _! I?_:___Liquid depth--. Capacity_ ________ ` f " /51 -- ---------- f Disposal Field: Distance from nearest well-_-4k_..._Distance from foundation___�_?" .......Distance to nearest lot line___., -____._ �� a Number of ylines___.______/- _- Length of each line____��____ _ * Width of trench-. __________________ Type of-filter materialy Depth of filter materia l___. ��f - Total length------/jM_______________________ W �. � . j Seepag Pit: Distance to nearest well_r_ �-. "Distance_f, o_m fo ndation_ �.y �. �,� .___.� is �r9ce to nearest lot ling__._�r-�.- Number�of pits-____`_____________Lining ;Z its Diameter__ .- -_..___ m r- r Cesspool: Distance fi;om nearest well________________`Distance from foundation...._._.____-'----.fining material___._.____________-__-__-_________._. *- ❑ Size: Diameter---- ---- -----------------------------Depth-----------------------------------------------------Liquid Capacity- ---------------------------gals. Privy: Distance from ❑ {m nearest well-------------------------------------------------Distance from nearest building--------------------------------------- Distance #oline---. nearest lot line ___ �----- A Remodeling and/or repairing (describe):__F_ -_�_ ...____ ./x-. ._-:_ G J ____--� d1Ae�, ----__-_---- --•-------------------------------------- ---------•------------•-••--••------- •------------------------------------"--------------------------------•----------j------------------------------------=-------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------•-----•-------'-----------------------•--------------- t----------------------•--------------------------------------- p I I hereby certify that I have prepared this application and +hat 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)--------------- _ 167- - -- —- ---------------- ----- ------ - - - ------- ic - - - ---� ('DContractar) BY:----------- •-•---------------------- ` (Tale) I 2 / ---- ---------------- ------ (Plot plan, showing size of lot, location of s in-relation-to-wells;-buildings,-etc., can be,.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- ---- - -- ---- --------------------------------------------•-------------------- DATE------ ------- t REVIEWEDBY------------------------- ------------------------ --------------------------------------------------------------------- ---- DATE BUILDINGPERMIT ISSUED-----------------------------------------------------------•-------------------------- ------ DATE----------------------------- ---------------------- Alterations and/or recommendations--------------- - -------------------------•-- - ----- ---------------------------------------------•---------------_.-------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- I------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ----------------------------- -------- ---------•---•---- ---------------------------------- --------------------------------- ----I--------------•----------------------------------- ---------------------------• I -------------•---------------•-"-------------------------------------------- ------------------------------ - ---------------------- -------- l FINAL INSPECTION BY- ------- - ------- -------- --- - ------ --------------- Date-- 1 . t SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street i ,�, }"i 132�Sycamore�Streef� 814 North "C" Street Stockton, GalifornieLodi, California Manteca, California t k' Tracy, California r � ES-9-2M Revised 8-'59 F.P.Cei. -�\