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3 . 7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .___JeA4 9. 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..... ------ .----------------- z --------------------------- Owner's Name------------- = A------ i?_ e_S,C--- •--•----------------------- ----------• Phone-----------------••- Address----....... ,r4 '............... Contractor's Name------------ S 5 rtl, = _ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_/___1 Number of bedrooms-. Number of baths __YLot size ---------_ZTLp-jO�,£ ___—_____________________ Water Supply: Public system ❑ Community system ❑ Private 14 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S pticrT k: Distance from nearest well-----------------Distance from foundation___________________Material-______.__________.._____.____._____.._._.______- $]1 NN J No. of compartments--------- j Size------------------------------ Liquid depth--------------------------Capacity--•----- is o I ! 'eld: Distance from nearest well. Distance from foundation__ � l_____-Distance to nearest lot lin _.__._ [elf ! Number of lines--------------- __ ____Length of each line_______7s_ _--____.-_.Width of trench---=p ee" _______________ <� i' Type of filter material----- ��----Depth of filter material--- length______ __________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line___--------_--.- ❑ Number of pits______________________Lining material-----------------------Size: Diameter----------------- Depth__.._____..___.-____----_._______ Cesspool: Distance from nearest we11_________________Distance from foundation----------------.--.Lining material-----_-_..____.___---.--._.______-_. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------._Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______.____________________________- "O ❑ Distance to nearest lot line------------------------------------------- - ----------------------------------------------------- -------------------------------------- Remodeling --------- -------------------------Remodeling and/or repairing (describe:__ ------------ ... _________.__ _._ _ -• '______ '�'____. ---------- -- - ----- --_---- �-------------- -----------------------------•----------------------------------------•-------•--------------------------- - ---- --- -- -----•-- ---------- -----------------------------------------------------------------------------•--•-------------------- ---•----------- ----------------------------------------------------------•------------------------------ ---------------------•------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared t ' a plication and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ules and re ation of the San Joaquin Local Health District. (Signed)------------------ u _.Vii_____. Owner and/or Contractor) By:------------------------------------------------------------------ -- ---- --r�----- ----- --- ------ -- --- -------{Title) ------ (Plot plan, showing size of lot, location of system in a ation to wel s, buildings, et. ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- -------------- - -------------------------------------- DATE--------- --c------------------------ REVIEWEDBY--------------------------------------------------------------------------------- ----------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- --------------- Alterations and/or recommendations----------------------------------------------- -------------------------------------------------------------••-----------------.-__.-..---------------------- _____________________________________._.____________..______-____If_.____.-_-__________.__-_-___GL -------------------------------------------------------- ------------------------------------------------------- --------------------- a ------------------------------------'---------- --------------•------------------ --- --- FINAL INSPECTIOt BYE. . -------- Date-----l__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi. California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Co.