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APPLICATION FOR SANITATION PERMIT Permit No. ...1�.. ..1. ' li D i l (Compete n Duplicate) 3 , Date issued ______1-�..la=a This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application. is made in compliance with County Ordinance No. 549. z Y r JOB ADDRESS,AND ATION .___ - - --- -- ` •------- -- ----------------------- j Owner's Name - - ;Phone. Address_ �j�r P. s'd -----------------------------------------------------------------'-------------------•---•-------------•--------- Name ----------------------------- Contractor's =Phone. Installation will serve: Residence gR' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ c -----------------------------------------------•-------- Number of baths _�---- Lot size TM Number of living units: _L_._ Number of bedrooms _� i Water Supply. Public system ROCommunify system ❑ Private ❑1 Depth to Water Table. ftp. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ®/!a4'ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes qJ-110 ❑ FNA/VA: Yes K�' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r3} (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Distance from nearest jeL___ � "___Distancefrom foundation_ 1�_____-_-Material____---Pk ----Liquid epth_"_/. _y-------- -- Capacity__ p--�-p No. of compartme _ --- -----------Sizey Disposal Field: Distance from nearest.well__ ____ _ -----Distance from foundation___-64*--------.-Distance to nearest lot line---- Number of lines ___JJ _ _�/,, Length of each line______4?_'--------------Width of trench__ '`�---------------•- of filter material.l- �L�'�.Depth of filter material-___" (!_________ Total length___. _________--------------------- Type W Seepage Pit: Distance to nearest well--------- +'__-- Distance�m foundation___ /-_--.Dist nce to nearest lot line_____.S __.-__ p ) Number of pits-----!---------------Lining maternal__ -_ 0 --Size: Diameter_��---- Depth- �'V` !" Cesspool: Distance from nearest weli------------------Distance 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):--------------1)WxV_.1_1te�_1_Z�;I ____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, and_ruIV and regulations -of the San Joaquin Local Health District. . (Signed) /w -- - � - ------------------------------------------------- --(Ommm==Wor Contractor) By:-------------- --- --- - -------�----------------g----(Title)----------- ,I`C . ! (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �. DATE---`3----------------------------------- ----------------- APPLICATION ACCEPTED REVIEWEDBY------------------------------------------------------------------ ------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------- --- ---------------------------- DATE------------------------------------------------------------ Al+orations and/or recommen tions: - - -------- --•---..-• _ - -- --- -------------- -- tz? * -------•-- - �/ ! l✓-0-------------------------------- - --- FINAL INSPECTION BY:-�- '-'---�---'- -•- --ptt�c.��1��.- ----- Date ---�-�------ - -- �,. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streo+ '• y 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised a-'59 F.F.Co�