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APPLICATION FOR SANITATION PERMIT Permit No. .../.aJ�.(Q in Duplicate) 3 (Complete P Date Issued ......�9, ;�.0=•,, This Permit 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 Qrdinance No 49. JOB ADDRESS AND LOCATION.... `S'' -------------------------------------------------------------------------- Owner's Name----- -------------------------------------------- ------ Phone------------------------------------ Address ---------si ar c-----------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name-------------------X00--f1_46'r-al —------------------------------------------------------------------------- Phone..--------------------------------- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms. Number of baths _I___ Lot size -_/_3....___ /R 7_-__.-______--__-_______•-_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -$(I'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2;,--Hardpan ❑ Previous Application Made: Yes ❑ No 9RO" New Construction: Yes [iR—No ❑ FHA/VA: Yes [s].--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` Septic Tank: Distance from nearest well------- --------Distance from foundation_A9----------Material ___C4-_A&/` ----------- 11 No. of compartments-----Z_______________Size-.,�___ `°__Liquid depth____lj_�_� --________Capacity.. 8___-.--- Disposal Field: Distance from nearest well_ -- ------_Distance from foundation.... ...._.Distance to nearest lot line_____..... ^� Number of lines--------/___ - __.__Length of each line___.9�`_________________Width of trench____.� `%._.__.______.___ -� Type of filter material-/I/IK'f�1�/ Depth of filter matenal__,��____ g �`-------Total length �`-------------------------- Seepage Pit: Distance to nearest well______~__ Distance from foundation-----40-O_.___.D'st rice to nearest lot line-_a4 _-_ 'e, --- of Number of pits-----/---______ Lining material.�jtf�° _Size: Diameter___ p �1 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):-----------Ae.-O------ -------- ,o. % ______________________ ------------------------•-••--••------------------------------------------------------------- •-•----•---••--------------------------•-----------------------------------------•----•----------------------------------- ------------------------------------------------------------------------•----------------------------------------------------------------------------------------•-------------------------------•---------------- 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 regulations of the San Joaquin Local Health District. (Signed)----------------------40_40 --(SSC Contractor) -- --- -- - - - - - -By: ------------ - - (Title) - (Plot plan, showing size of lot, location of s in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ----- - --- - ------------------------------•---• -------------------------- DATE---------- - - -- - REVIEWED BY---------------------•--------------------- �--------------- - - ---------------- ---------------- ------ ---- - - --------------•----------••--------------------•-------_._------._ DATE----------- --- -----------------------•------------- BUILDING PERMIT ISSUED ----------------------- ------------------------------- DATE...---------------------------------------------------------- REVIEWED and/or recommeQdations----------- ------- ------------;711------------------------------- ....... ----------------- •---- - ------------------------ � '. -- = _ _.,_ ----V - �.._�'..,,�/.. -----•------------------ ------------------------ -------------------------------------------------•----------------------------------------------------------------------------------------------------------------------- ----------------- --------- ------------------------------------------------------------------ -------------- FINAL INSPECTION BY:.-.- ----- -- - Date....�------ ------ . 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.