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APPLICATION FOR SANITATION PERMIT �° Permit No. . (Complete in Duplicate) Date Issued --f%44.61 m 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 Or anc No. 549. JOB ADDRESS AND LOCATION.-,/_C. T-- ---- -----------r-- --------------------- Owner's Name---- • f Phone------------------------------- Addressfll ----------------------------------------------------------------------------------------------------------------------- , Contractor's Name----------� i � ----------------- --- a Phone------------- -•--•----- Installation will serve: Residence Apartment House-❑ ,=Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_ :lNumber of bedrooms j--- Number of baths __/__ Lot size 2 t- _---____----__----------------- Water Supply: Public system �ommunity system El .private ❑ Depth to Water Table $�'ft. Character of soil to a depth of 3 feet: Sand 1711 Gravel ❑ Sandy Loam ❑ Clay'Loam ❑ Clay ❑ .Adobe 2--Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes g?"'No ❑ FMA/VA: Yes g?-"I'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , L ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I < Septic T nk: Distance from nearest well----- --------Distance_from foundation----��--------Material--6-�e---4, - ------------ a._� ,X_ _-Liquid de th----. capacity � _Q._---- No. of compartments_..._ ._.Size._ _._. __ � � DisposalField: Distance from nearest well.._.:"" --------Distance from foundation___,:AQ---------Distance to nearest lot Iine_�+�7'___. Length of each line--:--- - _%�_ Width of-french.__ ._�f--------------------- �- • Number of lines_______ L ��.___ g �_. Type of filter materiaf__� / '_Depth of filte meicxl- -��__.___Total length------4,0_7P___`______________ _ W. -- s Seepa Pit: Distance to nearest ell----------------------Distance from foundation____/O........ D"t nce to nearest lot line....E _�... ,. i Number of pits......................Lining material__ fl.-1r.%�i�_Size: Diameter--- _._...---Depth_ ...�.-- _ ------------ d � . Cesspool: Distance from nearest well-----------------Msi4ance from foundation--`--- _---_--.---.Lining material----------------------------------- .. • _ - <. Size: Diameter_______________ .___. ___.-_----.-..---- De rth .. - . . . _._._----Liquid Ca acct as. Privy: Distance from nearest well "'' -------------------------- f_:-------------------- ---- Distance from nearest building----.--------- .-___----:--------- ._. ❑ Distance to nearest lot line_ _---.- --------- _- Remodeling and/or repairing {describe:---- s ------------------------------------------------------------------------------------------------------------- ----------4--------------------------------------------------------------------------- -----------------------------------------------------------=---------------•--------------------------------------=--- - -------------------------------------------;-----------------•--------------------------------- 1 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 d regulations of the San Joaquin Local Health District. (Signed)---------------------- ---- ------------------ ----J `or Contractor) By: = � '- (TifileJ__-47 '---------- -------- (Plot plan, showing size of lot, location of sys n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _nom i APPLICATION ACCEPTED BY---------------- ----- --- - -'`- - DATE-------------- TE ----` -- ----------------=-=-------------------- - --------- REVIEWED BY DATE - BUILDINGPERMIT ISSUED------------------------------- ---- - = `"` ------------------- -------,------ DATE.------------------------------------------------------- Alterations and/or recommendations:----------------- ------------------------------------------------------------"---------`-------------•--------------••-----------•-------------•---------- ----- �- - ---- -- -- ------- -------- -- .. " - ---- ------ ----------------------- --� �>------------------- -------------------------------------•-- -- -------------------------- -------------- ------------- ------------------- ----------------------------- FINAL INSPECTION BY:------------- � tL---- -------- Date-------- -•----- i.1t)----------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street +� t 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California 'Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.