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APPLICATION FOR SANITATION PERMIT Permit No. Z .7--.9-0 (Complete in Duplicate) 6� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei ascribed. This application is made in compliance ith County rd' ce No. 549. x/ JOB ADDRESS AND "AT •••-- II// // //-- Owner's Name_____________ Q �.r� C1_c •/ ••------ ----------------------- Phone../xf'�--' -J,2� O Address--------------------------------------- -/_ Contractor's Name Q - 47`�/------------------------------------------------------------------••---- Phone-�-�--`��'------`-- Installation will serve: Residence PO'—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./___ Number of bedrooms __�_a Number of baths J_.__ Lot size --------S0-----X_1SSCJ--------------------- Water Supply: Public system 0KCommunity system ❑ Private ❑ Depth to Water Tables�_� _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ eHardpan ❑ Previous Application Made: Yes ❑ No [t'`Iew Construction: Yes No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well____...___ Distance from foundation---X1.0._!--___--Mater�l--- ---------------- --- - No. of compartments_.PFR!vw_ O—�__o�--_Size_,,�6__X---f _0__.___Liquid depth------ /�_----_Capacity..?................ Disposal F' Distance from nearest well----.r-----Distance from foundation-,10. Distance to nearest lot lineaS_!___••-•- Number of lines......___/_------------------------Length of each line-------- Width of trench__ y��______.__.______.__ Type of filter material_ QG.1<-__--_-_.Depth of filter materialjS--_�_________ Y' Total length-------- 0 -- _ -. ______________________ p� Seepage P' . Distance to nearest well------'-.__Distance from foundation__/p............Distance to nearest lot line-----+ _L.-Number of pits------)--------------Lining material-_- —-----Size: Diameter._. 3_____._.__Depth_....s;-Is_-/-__._-----____-- 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 line------ -------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): ------ -----' ------"-----------•---------••-••--------------------------------------- ..••----•-•-•'-•••••--'-•---------------------------------------------------------- ------------------------------------------------------------------------------------------------ ----------------------------• -----------------------------------------------------------------------------------------------------------------------------------------------------z----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------•'•--------------------------------------------------------------- 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 regulationAffin n Joaquin Local H alth District. (Signed)------41oction -- - --- -- --- ------ - � �--=�'-�------- ----(Owner and/or Contractor) By:•-••--'-----'•••"--''-•... --------------- - ---------------(Title) ------ -- - ---- - - -------------- (Plot plan, showing si loof system in relation to wells, b ' tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY REVIEWED BN--ACCEPTED BY-----------------------------------------Lr -----------h`��"r_�!yf�•:.'------------------------------------------- DATE------- l#�------------------------------ - - ------------------------- DATE•-•--_ ---------- ---------- ------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------.........--------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:..- -----------•--------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- FINAL INSPECTION BY:•-�--=-- --� ?�L Date 15-- 1�' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.