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/* k APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 AN,D,,�OCATION.___,?_4o;,,3------g, r�,l ------------- --------------------------------------------- Owner's Name ------------------- -- Phone ------------------------------- Address-.--_- f. -� Q�----------------------------------------------------------------------*--------------------------------------*--------------------------- Contractor's Name-------- - -- - -------•---------- Phone Installation will serve: Residence Apartment House Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: = -__-- Number of bedrooms --/-- Number of baths _-/-_ Lot size -- Water Supply.PPY. Publicsystem U?"Community system ❑ Private ❑ Depth to Water Table _�Ir ft. Character of soil to a depth of 3-feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 93-"H_`ardpan ❑ Previous Application Made: es-U3"No ❑ New Construction: Yes g?""N o ❑ FHA/VA: Yes ❑ No R4-- TYPE OF INSTALLATION AND, SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest weqll----, '0-----Distance from foundation---lQ__.-_----IVateriai-L No. of compartments_-__cC.----------------Size-4y__vC__�{p_........Liquid depth--- ___� r�9- - Capacity--- p- Disposal Field: Distance4from nearest well.-+::,,Q_._--_Distance from foundation----lrf-/......Distance to nearest lot line_,,. ----- N Number-of=1 ines------------------ ----------------Length of each line-------� ........,•--------Width of trench-- Type offilter material /37__z 6_Depth of filter material----./d!�'__. -Total length-------- 0�_____------------------- i Seepage Distance to nearest well_f� _______Distance from foundation---, 0�--_-_.Distance to nearest lot line-- _� W Number of pits------- -----------Lining material---- v.G --.Size: Diameter_._�U_ `� _ Deptly . �------------------- ^ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----...-.-----..----------_.--------_. n ❑ Size: Diameter ---------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line--------------------------------------- ----------------------------- Remodeling ---------• --------•--Remodeling and/or repairing (describe):__- _--- ---- ----------------- ---------- - - - --- ------ ----- ---------------- 9 �--1�---------- ---------------- ----- ------------------------------ --------------------------------------------------- ---------------------------- ------ - -- f- - --------- ----- --------- 1 hereby certify that I have prepared this application and that the work will be done in accordance vrifh San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- �' ------------------------------------------- Contractor) - ---------- ------ --- �. ..� .. ; r By-------------•-------- --- ------- Ti+le 4 ------------------------------- ( 1 � --------------- ------------ ot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY E - -�rr� -:'_ ---------------•--- DATE------rr� REVIEWED BY. -_-- -- � --------- -�- ----- tl-,-�=-�� -------- DATE---------------------------- ---------------------------- BUILDING PERMIT ISSUED--------- --------------- DATE------------____-- ------------------------------------------------------------ ------------------------------------------ Alterations and/or recommendations: --___-_---.-.-..- --------- 0 �-� -------- - -- - -------- ---- ---- ---- --------- �� 5 C r -- /' .. ' = --------------------- ------- ems'------ ----------------- --------------- - ------- - ------------ -�z --- FINAL INSPECTION BY-- - -------------------------------------------------------- Date------- - SAN JOAQUIN LOCAL;HEALTH DISTRICT 130 South American Street 300 West Oak Street 132-Sycamore 5freet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California } ES-9-2M Revised 8.'59 F.F.Co, k