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- 4. APPLICATION FOR SANITATION PERMIT Permit No. -.1KC1 (Complete in Duplicate) Date Issued ._________ __�__Q.�` f This Permit Expires 1 Year 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 compplie--n ith County rdinance No. 549. JOB ADDRESS AN CATION ?-A�__►,I..--- a `t- tC{� ��a,a, �� . 1 �-- --- - Owner's Namer_4�►i1.�e------------------•-------- Phone-- _sZ--h ------ c -.. - -------------- Address----------- �. /_C S _: __-l Contractor's Name--------------------- •-----------� ---•-------------------------------------- --------------..---- Phone----------------------------------- Installation will serve: Residence q Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ ^� '7 c Number of living units: J____ Number of bedroom ms .�•_� Nuber of baths -� __ Lot size _____)_- _X Water Supply: Public system ❑ Community system ❑ Private IX Depth to Water Table -IS7 ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] Previous Application Made: Yes K No ❑ N.ew-Construction: Yes.K No ❑ FHA/VA: Yes ❑ No,K_ TYPE OF INSTALLATION AND-SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O Septic Tank: Distance from nearest well-- from #oundation_____ _C�______.M .tefial____ � �-._- __- �__---------- No. _.---_No. of compartments------____-�-______Size----------- x _.5 Liquid depth__._.__________ Capacity_____d" ---- - ------- -- i4w,ji-J&stance from nearest well.=.- , __._Distance from foundaf n-----1��-----.----Distance to nearest lot line___ ___._... Number of lines_______________ 4 _ Length of each line_____ _`r --------- of trench------ - Type of filter material '-�� D pmaterial1 g F. *� Qz_ _ e th of filter ___ ________________Total length Seepage Pit: Distance to nearest well-_------------------Distance froom`foundation--------------------Distance to nearest lot line__.______-___.._ ❑ Number of pits-------------- ------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- V\ i Cesspool: Distance from nearest well-----------------Disfan-ce 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):_____ _ ___-__.__-L__ ----------- ----------- --- _______--- �f ^ _ ,�� --- -- -- ----------- ---------- - --------------------------- _ �Lk-�V4 - --------------------------------- --------------------------- } --------------------------------------------------------------------------------------------------•------------•------------------------------------------------------------------------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, S to laws, and rules and regulations of the San Joaquin Local Health District. -- . (Signed)- --If- - - -- -- ------- --------- ---------------------- ---------------------------------------(Owner and/or Contractor) By:---------------------------------------------------------'------------------------------------------------------------ --------------(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 ---------- -- - b DATE (&�L BUILDING PERMIT ISSUED --• --------—-------------------------------------- DATE Alterations and/or recommendations---------------------------------------- ----------------------------------•-------- -------------------------•------------------ ------------ ----------------------------------------- ------------------------------------------------------------------ - - -------,-------------- ----------------- . . = ------.. = --- ------- ---------------- -----, . ... ---------- - �-~- ------------ - --- �7�� ---------- FINAL INSPECTION BY------- - --- -------- ---------------------- ---- ---------- Date--------------- _= _ _ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M Revised 8-'59 F.P.Co.