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APPLICATION FOR SANITATION PERMIT Permit No. ,�1.�.�,1 l--.- /� `-sCam lets in Duplicate) _�3------------- This This Permit Expires 1 Year From Date Issued Date Issued ___ __..-- _-- og•cr_ 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. 23 4�- ) ,t JOB ADDRESS AND LOCA.-TI-ON----- - fi-�-`-_-«'�--.- ---t7�•� -��'._..�"r�-=- • J ----��--� �� Owner's Name ' <. Phone._.... 1 Address ------------ Contractor's Name------------• - -9---�� Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I- -- ss�� Number of living units: __(_---- Number of bedrooms ,.7__ Number of baths 42. Lot size ---A4_0_Y _------------------ 10 Water Supply: Public system ❑ Community system ❑ Private gr--*Depth to Water Table 0ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe[3 Hardpan F] Previous Application Made: Yes ❑ No New Construction: Yes pp-O'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 T Distance from nearest w)__� _ , __�__Distance from foundation--- ----------Material--____ .e�"1`� _.. No. of compartments_____ _____ _.__Size_ _ __ Liquid depth__--1--0'_.._--_----Capacity__ p --------- ------ Disposal Field: Distance from nearest well.4�20------ Distance from foundation__f --- _..Distance to nearest lot line__ ---------- -_ -_-_----Length of each line--_ ' - Number of lines--------�___-- f��----------------Width of trench of filter materialf �_Depth of filter material_____A??_..Total length------/��---------------------- Seepage Distance to nearest well-. _. ___Distance fr m foundation---ZM.-------.fit a ��e to nearest lot line-a ------------ ___ Number of pits----f_ ----------Lining .�i_ material_ .Size: Diameter-,_,i-----------------Depth.... ------------------- �. Cesspool: Distance from nearest well--_--_-_.-_____-_Distance from foundation--------------------Lining material_________.--------._-_-----_._.-__. � ❑ Size: Diameter------------------------------ -------.Depth----------------------------------------------------Liquid Capacity- ---------------------- -gals. Privy: Distance from nearest well---------------------------------------______---Distance from nearest building------------------------------------------ . ❑ Distance to nearest lot line----------------- ----------------------------------- -------------- --------------------------------------- Remodeling and/or repairing (describe):----- ------------ ------------------------------------- *- ---------------------- --------------------- ------------------- ----------------:----------s---------------------- -----------------------------------------------------------------------------------------«_-_-------_-__-__.-.---_---__---_-_-_-R'_-_--__------______-----.-._---_-._---._ ------------------------ -------------------------------------------------------------I.__-----________--__-_--___________________.---_____________________.____________.______________-.-_----__-.-..__-_-__._-.-.--___-----_- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul5y and regulations of.the San Joaquin Local Health District. x (Signed) ----------- -------------- t6w Contractor] j/r1/' B ' "�-r�rX60-- - --------`—-------------------(Title)....... --o7 -- - -- --------- J Y:-------------------------- - (Plot plan, showing size of lot, location ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY--- --- ------ ----------------------------------- -------------- DATE a----------------------- REVIEWEDBY---------------------------------------------- -- ---------------------------- -----------------------•- -------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------- --•------------------- ------------------------------------------------------------------ DATE------------------------------ ----------------------------- Alterations and/or recommendations-------- ------- -----------------------------------------------------------------•------ -------------------------------- j--------------�------------------- - -- - -r 1)Isap rt4----- -. ��`K= '------------------------------- ---------------------------- j --- ---------------------------------------------------------------- ----------------------------------------------------- FINAL INSPECTIO -------- Date... �`' --------- ------------------------ -- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised S.'59 F.P.Co.