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�S 1 Il a Y�' �} APPLICATION FOR SANITATION PERMIT Permit No. ...•................ (Complete in Duplicate) f 411 JJ Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to ton tru t and install e w rk rein described. This application is made in compliance with County Ordinance No. 549. (X • 1_* JOB ADDRESS AND LOCA ION_________ _______.__ _ � ___��_______ r --- r ----�---------- . • � �N"° 0�2_('coo--f!. . Owner's Name----------- i._.__.- ...-•------- Phone. ' Address ................................... 7 --------- ---- Z p Contractor's Name '. ----- ---------------- - ---------• ---------------- Installation ----- Installation will serve: Residence``❑ A rtment House �y Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___,C__ Number of bedrooms __-—Number of'baths _--2'Cot size --------I-S.. — Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: ` Sand ❑ Gravel ❑ Sandy Loam. Clay Loam ❑ Clayo Adobe ❑ Hardpan ❑ a Previous Applicafion Made: Yes ❑ 'Nox New Construction: Yes No [IFHA/VA: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--M______Distance from foundation_/U____.____-Mate•r� _ __________________________ No. of i compartments_____---�'_________--__ -----Liquid depth__-__---_--f--------------------------Capacid-U-_ Dosfield: ---- Distance from nearest well_:='___._Distance from foundation_ /-C'3. Distance to nearest lot line-��SC_____ Number of lines---------________ --_�- Length of each line---------f0----__---_____Width of trench-------- _�L_� �____-__ � Type of filter m6feriaL__ _.Depth of filter material......;_______________Total length------------- _Q-__._-:--___-__-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from-nearest .well------------ --Distance from foundation-------------------.Lining,material------------------------------------- ❑ Size: Diameter--------------------------------------De Depth --------------------------------Liquid Capacity-------------------------•--gals. t Privy: Distance from. nearest well--------------------------------------------------Distance from nearest building__.__._._________._______________------- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- 4 ________ { ______________________________________________________________________________________________________________________________________________________________________________________ ________________________________ f , {( -------------------------- _-------- ____________________________________------------------------------------------------------------------------------------------------------------------------------------------------------- f _________________________________________________________________________________________________ ______ ________________________________________________ ____________________ ________ __________ 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)------------------- ---------- ------------ - - (Owner and/or Contractor) �� _ ��-�- rf''' ---------------------------------------------------------- ----------(Title)--------------------------------------- ----- ---------------- r (Plot pian, showing/size of lob, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- --- -------------------------------------------•------------- DATE /& --------------- REVIEREVIEWED ,- WED BY------------ --------------------=--------- --- --- ----------------------- -------- ----- ------------------- ---•- DATE----------------- -------------------- ----------------.. BUILDINGPERMIT ISSUED-------------------------- -- ------------------------------- ------------------------- DATE---------------------------------------------------------- -- Alterationsand/or recommendations:------------------------------------------------ ----------------------------------------------•--------------------------------------------------------------- I ----------------------------------------------------•--------•------------------------•----------------------------------------------------•----- - i r i Z ------- FINAL INSP 'P ECTIO Date------/ Jr 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 175.9-2M Revised 8-'59 F.F,Co.