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FOR OFFIC USE: ` �/ __ APPLICATION FOR SANITATION PERMIT Permit No. .--/ 6 --- ___-- -----_ ------ - ------- (Complete in Duplicate) Date Issued -.-•- - �J - - 'This Permit Expires 1 Year From Date Issued Ap ication 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------- ------ Owner's Name__- !� --------- Phone. .. -- 'z' �� Address-------------_ 1�2-�------•-•------ -_� ---------------•----•----•--•- • ------••------------- ; Contractor's Name-_ /l f _1_`G-��lh �1�----------- Phone --- Installation will serve: Residence 12f Apartment House ❑ Commercial ❑ Trailer Court ❑ itl ❑ Other ❑ Number of living units: -_ _._-_ Number of bedrooms .��Number of baths __/__- Lot size -_--__:_ ___ Z ------------------ r' Water Supply- Publics stem OQCommunit System ❑ Private Depth to Water Table 11 p ft. # pP Y�' Y Y Y ❑ p j, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam ❑ Clay ❑ Adobe_IT-_Hardpan ❑�' Previous Application Made: (if yes,date.-.--_----_---.----) No�_New'Construction: Yes ❑ No FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weU__91.N.e-__Distance from foundation----«_-----.Material----: -_ __ ------- 41\ No. of compartmentsSizex�� 3 - N ---Liquid dept'--- --`'-------Capacity------- -.__�_ __--____ -- -_ AllDispos I Field: Distance from nearest wellh.4&!._.Distance from foundation._..L , .--Distance to nearest lot line_....... Number of lines------- .__ _Length of each line__ Width of trench.---A-_4...... ... ................ Type of filter material. 'CI�----Depth of filter material----0ZS_`�.Total length------._ 1_,4.'_________________ _ F � Seeps a Pit: Distance to nearest,well_'_1'fo_(L-�---------Distance from foundation---7 --_.Distance to nearest lot line___ r. Number of pits---F�-� °�y� Lining material._-Ra_�----.-.Size: Diameter__._.��-_____.Depth____.. -------------------------- --- Cesspool:j Distance from nearest well__ ____________Distance from foundation...._.--------------Lining material-------------------------------------- ❑ Size: Diameter----- -- ----------------------------Depth-----------------1-------------------------- ----Liquid Capacity- --------------------------gals. fDistance from nearest building I Privy: Distance from nearest well--------------------------------------------------_ ---------------------------------------.. ❑ Distance to nearest,lot line-------------------- -------------------------------------------------••------....-------------------------------- ------------------- Remodeling and/or repairing (describe):---------- - --------- ------------- -------- •-• ------------------------- ------------------- ---------------------------------------------••------------------------------------------------------------ ----------•--------------- ( ------------------------------•------------------------------------------•--------....------------•--------------------------------------------------------------------------------------------. ---------------------------- j 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. r 'c! n._. lLQf U/C e------ ---------------------------(�r Contractor) (Signed) /_ �-� 11 _ 'i � X19- B --- --------------------•-•---------- - - ••--------- ---- -----(Title)---------------------------- ---------------------------------- ` Y (Plot plan, showing size of lot, location of system in re 'on to wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- _a -_ ---------- ------ DATE { 'DATE REVIEWEDBY--------------.------------------------------- ------------- --------------------------------------------- ---- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------• -------------------- DATE--------------------------------------------- -------------- Alterations and/or recommendations:.--__-.:_-------------------- = _�. --------------------- ------------- �J -' - - -------Y-•L :x... •-------/-1-- ----------- •-------------------•-•-•--- -----•---------------•- �------ -....�_* 4------- - --- -%_ �. ------------------------------------ ---- ---__ --- 4 FINAL INSPECTION BY:. w Date----------71 "•s� — - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California todir California Manteca,California Tracy,California ES-9 REVISED n-59 F.P.DD.ZM 6-60