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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) f0 a T Date Issued .__ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 LOCATIO �'--- _ L.c.1 ° -------------------------------•------------------------------------------------ Owner's Named �- '� Phone /d po--�------- L C ------------------------------ -- z Address � � ] - - -- --------------------------------- -----------------••--- - --. Phone... -------- Cantractor's Name,_ a ' vim` l6 Installation will serve: Residence M-`A_'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-./--- Number of bedrooms /----- Number of baths _/---- Lot size ZOO...-�-J-- --------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableau_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F] Sandy Loam ❑ Clay Loam E] Clay E] Adobe j9•-t•tardpan-❑ Previous Application Made: Yes [❑ No a,79e, Construction: Yes ❑ No A/VA: Yes ❑ No [9� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p499—sewer is available within 200 feet.) Septic T Distance from nearest wel................. ______________ i,tance from foundation-/.............Material---C- ------------' --C_ No. of com artments_____.. -- �� o-t� P �- ----Size._ ....----� �/-�•� ..Liquid depth---c�r�- -----.Capacity-----�--------------- ' Disposal Fi d: 'Distance from nearest well_'_ nce from foundation/_`_./---------Distance to nearest lot Iine__W�___-_/.--_-- � Number of lines-_--__._--_I----------------------Length of each line_----�0----_-_-_-_-__--.Width of trench___-!..J`.-' -.--.-.----.--- Type of filter material---Y_s7.5. . ------Depth of filter material--_1-_3.............Total length---------- -------------_-- Seepage P• . Distance to nearest well__ from foundation-,Z0--- --___Distance to nearest lot line__iS'_J___... Number of pits------I--------------Lining -----Size: Diamete r____,:�3. Depth_._.. .5_�________________ 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--------------------------------- -------------------------------------------------------------------,---- ----------------------------------- czb Remodeling and/or repairing (describe)=-----------------1-7-711rt -------- - ------ _----------------------------------------- ----------- --------------------------------------------------------------------------------------------•------------------•------------------ ---------------------------------------------------------------------------------------- -- ------------------------ ----------------------------------------------------- ------------------------------------------------------------------------------------------------------•---------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. Si ned - - --a f1© -Y'---- +^ f.-G._ —--------------------(Owner and/or Contractor) ( 9 ) By:------------ � 1`�•----- , +ss�------------------------------ (Title)--- --- ------------_-- ---------- (Plot 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---------- --------- --------------- REVIEWED BY------------------------------------------ -- ------ DATE----------------------- -------------- ------------------- BUILDINGPERMIT ISSUED------_----------- ---------------------------------------------------------------------------- DATE-------------------------------------- ---- Alterations and/or reco mendations --------------------------------------------------- ----------------------- --------------------------- L"T^ �f - CJx �� -`-----------------------•------ ------------------------------------------ -- ------- ------- ------ / ----------------------------- A (Aiv FINAL INSPECTI .---- - -- 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 2AA Revised 8-'59 F.R.Co.