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APPLICATION FOR SANITATION PERMIT Permit No. ...f�&7.//� ,. (Complete in Duplicate) l Date Issued ___ This Permit Expires 1 Year From Date Issued r 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. 2-`f/ — 2-8-0--07 `r 3LY.. .x.33`... U f 2 ,/- JOB ADDRESS AND LOCATION---_L�... / ' __.1.-. .L�-�__ t . -! ' - --r- r Owner's Name------------------- -- _ 1---- ---------•------------------------- --- --------------- Phone-------------:'-----------..----•-- Address---------------------------------- .. � . ......•`--- -� �' -...,1� ��J'/r�� r f Contractor's Name-------------------------------------------------------------------------------------------------------------•------------------------•---•--- Phone._._....--s--------------...------•• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I---- Number of bedrooms�.- Number of baths _1--_ Lot size ---- ------------ -------------- Water Supply: Public system ❑ Community syste Private U?"Depth to Water Table A�1_21t. t Character of soil to-a de th of 3 feet: Sand Grave{ Sand Loam Cla Loam Cla Adobe Hardpan p ❑ Y ❑ Y ❑ Y ❑ ❑ y E] Previous Previous Application--Made:-Yes ❑ No P----New Construction:-Yes•i�r-No'❑ -`FHA/VA7Yes'❑" No ❑�" TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: .Distance from nearest --------D,istance fr fou on__-f�__. -----.Materi I �- No! compartments______'~.k___.___ __ Liquid depth----- ---------------Capacity______ --------- of ...Size__ .. Disposal Field: :Distance from nearest well.. ,?_. -Distance from foundatio}�5---A-0 nearest lot line---_'y_........: W 'Number of lines.__._._t'�'�-,� ____ _ Length of each line------4�_a7---------------Width of trench------54--�f-_-..------- Type of filter materia1._ i_�..--Depth of filter material----.-- .U------_Total ,length_____ __________________________ Seepage Pit: Distance to nearest well---------`-----------Distance from foundation------------------_.Distance to nearest lot line-----._____-_-.__ ❑ Number of pits----------------------Lining material---------_-------------Size: Diameter---------------------------------Depth-------------- ..------------- O Cesspool: Distance from nearest well---- -----------Distance from foundation.__________________Lining materia l-___-_- ---- h ❑ Size: Diameter--------------------------'--- Depth------------------------------ Liquid Capacity r gals Privy: Distance from nearest well -.--. .-____-----------------------------------Distance from nearest building----------------------------- _.___._--- ❑ Distance to nearest lot line----------------------- + R ' ! ( reI: Remodelingand/or pairing (describe):----------------`-------------------- ------------------•-------------------I------------- ----•- -------------------•---•-'-------------•- -------------- ` --- --------------------------------------=---------- ------------------------------------ ------------------------=--------------------------------- ---- --------------- ------------------------ ----------------------------- - -- ---------------------- - . -- .. L: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. �' [i (Signed �L -------------------------------- -------------------=---_-----(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). FORD 0WE— T USf ONL f� ------------------ APPLICATION ACCEPTED BY;...___-_- t-- ----L/J' REVIEWEDBY------------------------------------------------------------------------------------------- ----------:'------------------ DATE-_-------------------------------------------------------- BUILDING ATE- ----------------•-------------------------------------- - BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------t------------------ DATE-----------------------------------------------------------' Alterationsand/or recommendations:------------------------------------- --------------------------'- •-------------------------- l ----••----------•------------------------------- -•------------------------------------- --------------------------------- -------------------------------------------------=------ --------------------------------------------------------•-------:--------------------- ---------------------------------------------------------------------------------- - ------------------------ ----------------------------------------- -----------------------------------•-------------------------------------------•- zl� ---�----- ---------------------' ----------------------------------------------------- - -------------------------------- ------- ---------------------------------- --------------------- ----------- - r FINAL INSPECT � //1n! --------- __JDate----- GI- / L, �1 J r SAN'JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy. California ES-9--2M Revised 8-'59 F.P.Co.