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Permit No..... APPLICATION FOR .SANITATION PERMIT :- *ems lS (Complete in Duplicate) s; Date Issued V�=j :I_ r"This Permit'Ez ices 1 Yea 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. i I � JOB ADDRESS AND LOCATION.... -Z_5-�------ --- -J -�-----------------------------------�---------------•----------'-----------•---------------------- -- ----- 1.s-- y�' ��r Phone----------------------------- - Owner's Name-------- __ ---- Address- ------- .--- X - -- ------------------------ Contractor's _-- --- `� � +' ------------------------------------------ Contractor's Name-------sr Al -- - ---- ------------------------"------------- ----•---------•- --------------------- Phone----------------------------------- Installation will serve: Residence t& tiApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [_1 Number of living units: ---(-_-- Number of,bedrooms --Z_ Number of baths ----I--- Lot size __. ---450, S Water Supply: Public system Community5system ❑�Privatbr❑.Depth to Water Table 4.� ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe8L Hardpan ❑ Previous Application Made: Yes ❑ No-k New Construction: Yes 2�. No ❑ FHA/VA: Yes ❑ 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--- �_Distance from,foundation------,I-D-------.Material_G_Q__L n ` 'S�---------.___-----_ No. of compartments---------- ____----.Size '_�C$_`'-K-q .___Liquid depth-------4 YZ----------Capacity__$00 Disposal Field: Distance from nearest well--AONYR_Distance from foundation-----l-Q'--._---Distance to nearest lot line------ _-�...- Number of lines_-_-- --Z--------------- ------Length of each'line-----------2-tS:----------Width of trench---------Z tJ< 1�------------- Type of filter material----Ae?-�(S ____Depth of filter material-------tl .�-.----Total length--------- --------------------- �) Seepage Pit: Distance to nearest welt---------- .___Distance from foundation_--_.---___-_--___.Distance to nearest lot,line----------------- rf� ❑ Number of pits------ --------------Lining material---4--"" ----0-------Size: Diameter_--------------------Depth-------------------------------- V` Cesspool: Distance from nearest well-----------------Distance from foundation------------------Lining material---------------- .--------- l/ ❑ Size: Diameter------ I-----------------------------Depth--------------------- ------- I------------------Liquid Capacity- ------------•-------.-....gals. Privy: Distance from nearest well--------------------------------------------- ---Distance from nearest building t--_------------_--_.-------.----------. V ❑ Distance to nearest.lot line-,.----------------------- ------ --------------•-------------------- ------------ -------------------------------------------------------- 1 I Remodeling and/or repairing (describe)------ -------- -------------------------------- •-------------------- ------------------------------------------------------- _ i - - -------------------------------- f -------------------------------------------------------------------------------------------------- t•-•----------------------------- ----------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signe - --------------------------------- --------------------------- -----------------------------------(Owner and/or Contractorl By:--------•--------------------------------------------- ----------------------------- ---------------------------------- -----(Title}-----------------------I-------------------- (Plot plan, showing size of lot, location of system in relation to:wells, buildings, etcf can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- I --------------. DATE------ --------------------------------------------------- ; REVIEWED BY S -----------------------I--------- DATE------------------------------------------------------------ REVIEWED -------------- BUILDING PERMIT ISSUED------------------= ----- t c - ------- --------- DATE Alter 'ons and/ r recommendation _'--.- -_ '. '_-`� �' -- '� = Z = -------- c. `re---- --- -- --- _-c -=� --- ------��'-- -�`.+ s -, "---------------------------- ----------- �'----------------- - C'-' Ste. m 14 mc ------ z t ° ;�; 'ASF?e .M. .M 6' FINAL INSP TION BY: Dafie ; C, � SAN JOAQUIN LOCAL HEALTH DISTRICT 1' V , 130 South American Street 300 West Oak Street 132 Sycarnore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.