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��• �� --- APPLICATION FOR SANITATION PERMIT Permit No. ._....�_ .z2� 7" (Complete in Duplicate) Date issued .___ This hermit Expires 1 Year From Date Issued 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 Ordina o. 549. rob JOB ADDRESS ANDCATION..... ........ .... .. .t �C� ... ----•-• Owner's Name-------- ---- Phone.* "�- j Address....................................... C� - ------- --------;--•-•--- ------------------•----••-------------------------------• . . . ...................... Contractor's Name---------------------------------�•---.......�---------- `----------.....---•-----..----- Phone i fc.. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelOther Number of living units:4-- Number of bedrooms _4__ Number of baths f f -- Lot size �t2_0_.___�/-3 Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table-'Z2- ft. .w Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe • Hardpan ❑ Previous Application Made: Yes ❑ No'[- New Construction: Yes ❑ No�k FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: a Distance from nearest well_________________Distance from foundation...._---------------Material-----------------------------------------........ S'fi� No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. ❑g�kiStilVg Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------ Type _-.--_-_-_-_-:-•_____._Type of filter material.•_. -Depth of filter material------------------?----Total' length.......................................... i V See pa a Pit: Distance to nearest well_� ___--_Distance rom foundation_...t 2-_--_-.Distance to nearest lot lin?---- Number of pits_('�- �1 Lining material.___A '____.Size: Diameter-_� ___ .___Depth_- ___.____--_.-_____• Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------- _________.___________-._-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from,nearest building___-___.-_.____-__--_•--•--___._______--. ❑ Distance to nearest lot li ---- ------------------------------•--- ------------------------•---------------•------------------•-------------•-------- a o 0 Remodeling and/or repairing (describe):--- �* _ _----------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------• - ------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------- I hereby certify that I have prepared°this application and that the work will be done in accordance with San Joaquin County ordinances, Stal laws, and rules an ulations of the San Joaquin Local Health District. _ (Owner and/or Contractor (Signed) 1� - SQ �1!__ 4-=^�--= ( / ) o By:------------------- L A -------- - ---------------------------------------------------(Title)---- ------------------ ----- --------- (Plot plan, showing size�olot, location of system.in relation to wells, buildings, etc., can be plareverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------- -•-------------------------- DATE......... '�� ' ------------------- REVIEWEDBY--------------------------------------------------------- ------------------------I--------------------- -------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED.. - - DATE--------------------- i--------------------------------------- Alterations and/or recommendations-- ----- -- ---------------------------------------------------------------- -------- -•-•--------------------------------------------------------------- r ---- -- -- ------ ----- �1-------------- - t0 -t� dal ------------------------------------------------•----------------------------------------------•--•--------------------- ------------------------------ ------------------------------------------------------------------------------•---------------------------------------------------------------------------• -------------------- ----------------- ---------•------------------------ ------------------------ ---------------------------------- ----------------------------------------------------------------------------------------..------`--------------------------------- FINAL INSPECTION BY:.--------------- -------- - --------------- -------- Date--------------- l 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.