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APPLICATION FOR SANITATION P P� PERMIT � '��ermit No. ."42-Q....(Complete in Duplicate) This Permit EDate Issued .-- x ices 1 Year From Date Issued �� istrict for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health D [ This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._-f-__►._„ ,�, =,j e Owner's Name ----------- A I— Address-------------- ------ Phoneee_..1-----------• ------ +t . ----------� - - ' Phone `s -------------- Contractor's Name---__-__.. t _ Installation will serve: Residence [' Apartment House,❑ Commercial-El Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _"-�.Number of bedrooms --__� 1Nurriber of baths_,/' .Lot size _"_"_"" _-._"" Water Supply: Public SYS"�tetn ""�--•----•--- � pP Y ❑ Community system 0 Private ❑ ',Depth to iWafer Table _2--� ' "-- ft. Character of soil to a depth of 3 feed: Sand [] Gravel ❑ Sandy Lo r; 0 GIa o m ❑ Clay El Adobe J�' Hardpan C]Previous Application Made::. Yes �' No � New Construction: Yes ❑ AN j� FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND'SPECIFICATIONS. (No septic tank or cesspool permitied'if-publics.sewer isaila6le hin 200 feet.) Septic Tank: Distance from nearest well_-"� _-__N'�Dis$ance from foundation--------------------Material No. of compartments_..-_--.-_ _-" _ t ------- Size Liquid depth------------- Capacity Disposal Field: Distance from ne irest well-t_ -__-- _��ength of eaAfpundafion----- 9? Distance to nearest lot linel a_ I� Number of Imes _"__--_-_ -* i line--------adv--- Width of trench Type of filter material----mo i_ staof-filter"`m'aterial__../_1- " i Depth ------Total 10 ---------------- I = Seepage Pit: Distance to nearest well- ----- nce from fou_,ndation-" Number of its"""." D f '�'' •----Distance to nearest lot line_,,�'+�_ ,• P k ----------Lining material_-s�-.�-rc�---.Size: Diameter---- ��---___De th------ 'a `, ---- P -a'-------------- Cesspool: Distance from nearest well "_,Distance from joundafion.____--_- Lining material._. _._--__"""-_""_ i T Depth Size. Diameter --------------------- ----I-------------- ----- I - -------_-""___"-Li Liquid Capacity Priv q P tY- ----------------------- gals. GA Y Distance from nearest well""- --_- : '°Disfiance from nearest building--. Distance to nearest lot line__-------------------- Remodeling ar2d/or repairing {describe}:----_-_-- Grp R '"� .� �- ' - --------- ---- __""""__-_""-_"_"._""___"._"""""_-___"""_-"_"-"""""__"_..""" ___--_•--"------- "_--•--'---------------------------------- -------------------.". ""---"" "."-_"__" ------------ -------•---•--------------------------------------1 4-------- s I hereby certify that I have prepared #his applipcation and that the wbrkzwill 6e done in accorda66 with San Joaquin County ordinances, State laws, and rules and regulafions of?the San Joaquin.Local Health District. (Signed)--- ----------------- f� � - 6 •►5---------------------------------------------------------(Owner and/or Contractor) �` (Title) (Plot plan, showing size of lot, location'of system in relation,fo wells, buildings etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - + F REVIEWED BY - ------- DATE-------- ------------------ ------- ---- I ------- �------- -----------�--------- --------•-----------------•- h � DATE-- UILDING PERMIT ISSUED------- t = DATE Alterations and or recommendations._""-."__� � ---- ------------�---_"""-__"__"___- --------------- -- ----- - -------------------------------------- ----------------------•------------------------------------------------- -- ---------- ------ -------------------------- - -------------------------------- ....... .-� ;; ;aye----- " ----------- �./ - FINAL INSPECTION BY > > --• ------- -------- -----•----- --•------- Date__.--- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+rest Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Re,ised 8-'59 F.P.Co.