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J�'• ��lo�I - v� V` �_ \ t , •.rte; 'y._�. _ � ,1 •APPLK ATION FOR SANITATION PERMIT Permit No, .._1. ..�..� A);O (Complete .in Duplicate] Date Issued This Permit Expires 1 Year From Date Issued I 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 OrdinaZce No. 549. -7 --•--- -------•-------------•-------------- 8 -��'-i JOB ADDRESS AND, L CATION_______S_`_------------------- = • - " --------------------- ------- Phone Owner's Name------ �J •------- / '/�'� y Address -p ---- 1,1z-; ". "` ! •----------------------------------- ----------------------•-----•--•-•-------•- _ -------------------------- ------------_-- Contractor'sPhone • - . Name----------------------/// r Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �3_ Number of bedrooms -,-?- Number of baths :n;?.- Lot size -•------------ ----------- i Water Supply: Public system [Community system ❑ Private E] Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay C] Adobe lardpan ❑ i Previous Application Made: Yes E] No R---New Construction: Yes ❑ No �NA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pf� nl<: Distance from nearest well-----------------Distance from foundation-------------------Material__________________._____-.____._______-.________. No. of compartments--------------------------Size--------------••----------------Liquid depth----------:---------------Capacity---------------------_- i Disposal Field: Distance from neares0well....-------------Distance from foundation-------.------------Distance.,to,nearest lot line_________________ ❑ Number of lines------------------------------= Len th of each line___ ---;----.----------- Depth of filter material-----------------------otal hle gth_�C___________ ____-_______----------- 9 C Type of filter material___._ _ _______- __- p Seepage Pit: Distance to nearest well:-----Distancerorrt foundation-- -.Distance to nearest 1ot:line ` '. Number of pits------ — ------- 9 er_ ��---------- ..Depth_.- '� _Linin material- D_._ Size: Diamet Linin material_' t Cesspool:- _ Distance from nearest well-----------------Distance from foundation-------------------- g .. gals, ❑ Size: Diameter F `--- -'�-�-----------Depth---•-------------- -------------`-------------Liquid Capacity-------=----•--3---• 9 Privy: Distance from nearest well------------------------------------------------- from nearest building___._.____.________.__._____________.____. ❑ Distance to nearest lot line-------------------------- ------------------------------------------------------------ --------------- - R'emodel'sng and/or r�pairing (describe):-- e��' C j � '✓ ....... ' ---�'�---'`-�'-`------------- ` --'-- -�io �c � 1 art--ems, ....^--`�.r-�-='f-- -- ------ --- ----------------------------------------------`------------------------ -------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,/"e laws, and rules and regulations of the San Joaquin Local*Health District. _ (Signed} --Owner and/or Contractor( d/o ` ' '==_Z- 5'1 = ---------------------(Ti+le)- -- -------------- By--------------------------------------------------:----- , (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY p--- w APPLICATION ACCEPTED BY-- DATE.._ �" / REVIEWEDBY------------------------------------------------------------------- DATE-------- -------I---•---•----------------------------------- BUILDING PERMIT ISSUED----------------------------- -- ---------------------------- --------- DATE------------------ ------------------------------------------ Alterations and/or recommend s+:ions.----- -------e--------------�------ - ------------------------"-------------------------------------------------------__------------------- ------ ----------------------------------------- ---- .- -- t =te ------ _---- - ------•----/•---------------- 1` ----- ------- --------- ---------------------------- I FINAL INSPECTION BY:____-_--.-.-___-._/c -� 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 F.P.Co. -