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APPLICATION FOR SANITATION PERMIT Permit No. _'/A. (Complete in Duplicate) �0Jr; Date Issued ---__�5_f��-.(�__ ",J: 20 /r© o/ Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work he eeLn described. _ 1 This application is made in.compliance with County Ordinance No. 549.��}� , r Ile" 'd_ �,Y y� R JOB ADDRESS ND LO ATION--- --T-2-2425---b--J-m' Q a Owner's Name ----------------------- - -- ------ Phone------------------------------------ Address -- --- ------ ---------- ----------- ---- -------------- Contractor`s Name_ J�--l �( '1 � , Phon`�-- 74- F_1A E Installation will ser Residence�' Apartment House ❑ C mmercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_.._ Number of bedrooms --R Number of baths _1_____ Lot size ---- dt''__19____________________________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Nt Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nddik New Construction: Yes D .N_o ❑ FHA/VA: Yes ❑ No ❑ j TYPE OF INSTALLATION AND SPECIFICATIONS: - ,� 5 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) } ,Septic Tank: Distance from nearest Distance from foundation---- -- No. of compartments____ . -----------Siz ' t!Liquid depth_ _�,.� __ Capacity--I ___!�__Qk Field: Distance from nearest well__�V_____Distant f m foundation___J_Q_f_____Distance to nearest I t line__ _- --------- Disposal Number of lines___ Length of each line_ _�i s -- r-C -- --- 9 .��.��-��►' _Width of trench -Type of filter materil__ Depth of filter material__ _ If-1 length___ _ _ !_ r -- -S'a Seepage Pit! Distance to nearest well__________________Distance from foundation____________-•____.Distance to nearest lot line----------------- . (� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter- ------------------------Depth--------------------------------- � Cesspool: Distance from nearest welt-----------------Distance from foundation___.----------------Lining material______________._-___.____-_______--__ .h ❑ Size: Diameter------------------------- ------Depth-----------------------•----- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_______________ _____________________________Distance from nearest building---------------------------------..____- ' ❑ Distance to nearest lot line_________ Remodeling nd/or reps�ir (des ribej � C - C '7`�� 's- ---- . o --------------- ,�__a ---- _ ---.-s=�---- - u�-u�-=-----�---------------------------- -------------- --------------------------- --- --------------------- ------------------------------------- ---------------------•-•------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County - ordinan s, ate laws, and rules and regulations of the San Joaquin Local Health District. .� 5r ned 4-1111--ht-194, ,p , - fig ]---- - ---- dy_ ___ 1 11--ht-19 �, Contractor), BY: s ------fritle]--------------------------------------------- C (Plot plan, showing size of lot, location of system in.relafi o wells, buildin , etc., can be placed on reverse side). �j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --# - ----------- `-- --------------------------------------- ------ DATE ~�--- ------------------------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------.----- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------ - - Aiterations and/or recommendations-----------------------------------------------------------------------------------------------•--------------------------------------------------------------- ----------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------•----- -------------------------- -----.--•-------------------------------------------------- ---------------------------------- ---------------•--------------------------------------------------------------------------------------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------- FINAL INSPECTION BY: ....... Date------�'�1',�A-7---- -------- ------ ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.