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APPLICATION FOR SANITATION PERMIT Permit No... (Complete in Duplicate) r Y119--1 "` This Permit Expires 1 Year From Date Issued 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 ------------- �S.faU._ ___ _2u J7,ife ------------------------------------------•------- ----------------------------- Owner's '------/--'- - Owner's Name N /eDd lC. '--------------------------------------------- Phone_!To_. � %� - ------ Address---------------------------------------------�._%"-----�---- - . C G !/� /li Contractor's Name--- -------------------• ----------------------------- --- ----------------------------------•---------------- Phone ----------------------------------- Installation ---•-••-✓----••---------- -Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __L-___ Number of bedrooms 3._ Number of baths /YLot size ------- 7� X 12--3 Water Supply: Public system D( Community system 0 -"'Private ❑ Depth to Water'Table ______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No [y New Construction: Yes [ No ❑ FHA/VA: Yes JK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- ------------- Distanc from foundati0-----J_-------Materi - ,f�r�--------- No. of compartments__________._.__.__Size--__x______ .__Liquid depth____________________.._-CapacitY_.____-_�J._Q__�__ Disposal Field: Distance from nearest well ----- '-_Distance from foundation ----- 4Q ------- .Distance' to nearest lot line_______ Number of lines---------3---------------------Length of each line----------- 0 ---------.Width of trench-------- .......... Type of filter materials �-______Depth of filter material ---- -IP -------- Total length ------------- — Seepage Pit: Distance to nearest well ---- NO ----------- Distance from foundation-IN_?�_..Distance to nearest lot ❑ Number of pits ---------- Lining material ---- FPC_)'„_ Size: Diameter --- 33.__._--_____ Depth ------ t ________________ Cesspool: Distance from nearest well ----------------- Distance from foundation --------------- .--_Lining material ____.___.__-_____._.______________-. ❑ Size: Diameter ------------------------------------- Depth-------------------------'------�-----------------Liquid Capacity --------------------------- .gals. r_ Privy: Distance fromnearest well. ____._,.___-.________________________________Distance from nearest building ------------------------------------------ Z:"' ❑ Distance to n Barest lot line----------------------------------------------•--------------------------------------------------------------------------------------------- \ Y Remodelingand/or repairing (describer---------------------- ------------------------------------------- ---------------------------•---------------------•---------------------------------- 1 ' t - i -------------------------------------------------------- I ---------- ----------------------------------------------------------------------------------------- --•-------------------------------- ?_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andirules and regulations of the San Joaquin Local Health District. i (Signed ------- ------- -------- ------ -------------------------------------------------------------- (Owner and/or Contractor) �'. By:--------------------------------------------------------------------------------------------------------------------------(Title} --------------- ------------ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed -on`reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------ ---------------------------- DATE----- - � �� - :� - -- ---------------------- REVIEWEDBY ----------------------------------------------------- --- ------------------------------------------- d----------------- D -ATE ------- ----------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendation_I. ------- __________._ It -•----------- -------------------------------------•------•-_x ----------------------------------------------•------------------------------------ f --------- ------ ----------------------------------•-•- ----------------------------------------------- .. - /-� FINAL INSPECTIO B --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES -9 2M Revised 8-'59 F, P, Co. 300 West Oak Stroot 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California