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J{ j APPLICATION FOR SANITATION PERMIT Permit No. -......"_./_"......-- - 1� (Complete in Duplicate) Date Issued ---6l�6 �Q 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 Ordinance No. 549_ JOB ADDRESS AND LOCATION__-.-I �------- -------- --'o-- - -------- ' Phone-- " Owner's Name--- Address---- •---------- �'�c�l----F,"41� - J 4-- ------ ---------------------------------------- > Phone Contractor's Name""" �--•-- -- � Motel ❑ Other ❑ Installation will serve: Residence �r Apartment House ❑ Commercial ❑ Trailer Court ❑ , R _" - �• Number of living units: -- Number of bedrooms __umber of baths J-__ Lot size Water Supply: Public system Community system El Private ❑Depth to Water Tableft• t. _ Character of soil to a depth of 3 feet. Sand E] Gravel F1Sandy Loam F-1 Clay Loam El Clay E] Adobe Hardpan ❑ Previous Application Made:-Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes E] No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Q_--------Material Septic Tank: Distance from nearest well Septic from fou dig ion"" �� Size" Liquid depth_ , -- Capacity No. of compartments__-------------- � ��. � Dispos i Field: Distance from nearest well_-9-aloe..Distance from foundation___-40� Distance to nearest lot kine""_. r � : 0__ ---Width of trench----•-- "5�"'!".--------- Number of lines -_ -------___--" Length of each line_ _".Total len thType of filter materiaLl. - Depth of filter material__" - g � e 0___.Distance to nearest lot line--.-- ------"_ Seepa a Pit: Distance to nearest well....h�_4 Pk Distance from foundation"_"_____----_- )� � CA ----I--------------Lining material___---o Size: Dia;eter.__j Depth------- -- ------ Number - .. . - 4 Cesspool: Distance ofromsriearest well=""__._""__""_-Distance from'.foundation------------------- Lining material-"".___.-._"_-._-----------------•- O -----De Depth ---------------------Liquid Capacity- --------------------------gals. ❑ Size: Diameter--_I-------------------------- p Privy: Distance from nearest building---------------------------- ----- Distance from nearest well__--------------------------------------------------------- Distance to nearest lot line.".__"".__.""__""-------------------------------- ------------ Remodeling"and/or repairing (describe):------------------------------------------------------------------------------ , --------------------------------------------------------- ------------------------------------------------------------- ---------------------- ------ ------------------------------------------- - r - -- tII ----------" I hereby certify that I have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, I band rules and regulations of th a Joaquin Local Health District. # r Contracforl (Signed). - ---------- " ! ----- �---------------------(Tit1 ------------------------------ -------- ------------------------------------------- e) l -- By"""--"""""""----"`---"""""��-""� buil mgs, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system in r io wells, t F DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-------- --------------------------------- DATE------- -- --r6-- -J�_------------------------------- ---------------- - ---- --- - -- ---- ------------------------•- DAT ----- -- -------- ------------------------------------ REVIEWED BY---- --------------------------------------------- ------- --------- --- - - - BUILDING PERMIT ISSUED-------------- ----------- --------------------------------• DATE-------- -------- - Alterations and/or recommendations:-------------- --------- --------------------- ----------- •---- - -------------- ---- ----------------------- 6 / .C ------- ----------------- ------------------ FINAL INSPECTION BY--------- - ----- -- --- -- Date ----- -- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 ,North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. Fs-9-2M Revised 8',59 F.P.Co. s,