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-7 1/ / 7If q/o APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued ---- This Permit Ex ices 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfhj�stricf for a permit to construct and in 11 the work herein described. This application is made in compliance with County Ordinal No 9, construct and in JOB ADDRESS AND LOCATIOW ..... . ... . ... -- ---------------------- -- ------- ---- ---------------------------------- L Owner's Name---- -- ------- - -- --------------------------------------- ------------------------------Phone,�O.. Address---------- -- ----- -- - ----- ------------------------ -------------------------------- ----i*------------- -------- .011di -.-/, __ Phon Mitg ----------- Contractor's _247 � �X_ / Installation will serve: Resideni--ef2r—Apartment House El Commercial 0 Trailer Court El Motel 0 Other El g n - m 'j� Number of living units: -/---Nu"_'Number of bedrooms 2-- Number of baths --/-- Lot size ---- ---- --------- Wafer Supply: Public system*Community system El Private F1 Depth to Wafer Table46Wft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam E] Clay C] Adobelzr Hardpan 0 Previous Application Made: Yes E] No E-1 New Construction: Yes 0 No-k - FHA/VA; Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_________________Distance from.foundafion------------------- Material------------------------------------------------- No. of compartments--------------------------Size-------------------------- -----Liquid depth--------------.- --- -----Capacity----------------------- a 1 field: Distance from nearest well_________________Distance from foundation--------------- __.Distance to nearest lot-line----------------- Number of lines-----------------------------------Length of each line-----------------------------.Width of trencb--------------------- ------------ Type of filter material-______________________Depth Depth of filter material__--______--_.___.----Total length---------------------------------------- Seepage Pit: Distance to nearest well A 0,4-419------Distance from foundation-/--)----------.0isfance to nearest lot Number of pif�_I---/---------------Lining material-'R.0 Size: Diameter. Depth--,es- ------------- 10 1 15- 3- Cesspool: Distance from "nearest well-____-.______-_Distancefoundation___________________Lining 'Material------------------------------------- F1 Size: Diameter--I-----------------------------------Depth----------------------------------------------------Liquid CapacitY----------------------------gals. Privy: Distance from nearest earesf well---------------------------------____.________..Distance I ' from nearest building_________________________________________ Distanceto nearest lot line-- ---------------------------------------------------------------------------------------:--------------------------------------------------- Remodeling and/or repairing (describe)------ ---------- ------------- ------ ------------------------ ---------------- t------------:------- ------------ ---------------------------- ------ --------- ------ ---- ------------------------------------ ---04-------- --------- --- ---------- -- ---------------------------- ------------------------------------ - ----------------- - ----------------- ---------------------------- -------------------------------------------------------1--.-'-#------------------------ ----------------------------------------------------- ---------------------------------------------- ------ --------------------- - Vh6reby certify that I have prZpared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat _ e laws and rules and regulations of the San J�oa uin Local Health District. (Signed)-- --W. 91- ------I Ye- -------------------------------- 4010 Contractor) ll I - - ---------- By:------------------------------ -------------------------------- --------- ---- -----------(Title)----------------------------------------- - - ------- --- (Plot plan, showing size of lot, location of system i in ion to wells, -ei�d�is, etc., can be placed on reverse side). 'on FOR DEPARTMENT USE ONLY - -------------- "Y10 ------------—------------------------------------------- DATE----7--- APPLICATION ACCEPTED BY---- REVIEWED BY-----------------------------------'------ -------------------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------�1 --------------- DATE--------------------------- -------------------------------- ----------------------------------------------------------------------- Alterations and/or recpmmendafions-.__;__,._ -------✓------ ---------------------------------------------------- ------------------ J_f: ---e�----------------------------------------------------------------------------- -------------- -0-A--------------- ------------------------•----•---------------------- ---------------------------------- --------------- -------- ---------- --------------- ------------------------------------------------------------------- ------------------------- ------------------------------------------------------------------- ----------------------------------------------------- ------------------------- ----------- ---- -------------------------------------------------------------------------------------------------------------------- ----- FINAL INSPECTION BY -- ------ - -- ------ ---------- Date-------;7--- r......... ",c Tib F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Ameii4n'SVeef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cdhli.rnia,�. Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F-P.Cc.