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APPLICATION FOR SANITATION PERMIT Permit No. .1;. ........... (Complete in Duplicate) i (a t3 •. Date issued 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 des ribed. This application is made in com liance with County Ordinance No. 549. C Q 33-��--- O�p J08 ADDRESS AND LOCATION--- �-�'-----c%��----�:---------��s'7�-------- --- - - ---- 0 Owner's Name----------------------- —-------r--l��G'� -� --- Phone------------------------------------ Address--------------------------------- S l � ✓1�t,¢ Contractor's Name ----------------------••--•--------•----------------------- Phone------.----------- ---------- Installation will serve: Residence AVartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ nr � Number of living units: __l_.. Number of bedrooms __-L- Number of baths ____L Lot size ------- ------------- Wafer Supply: Public system ❑ Community system ❑ PrivateV Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam' Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes Q No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' f // f/ Septic Tank: Distance from nearest well-____. _ __--Distance from foundation___________ __.Material__ jCs�:E�ad_. No. of compartments----------o?------------Size_---_ -x__J_>C-_cl_�_Liquid depth------ �_____________Capacity___ Disposal Field: Distance from nearest well._.,5_-0-------Distance from foundation__._ '_---------- Distance to nearest lot. e____a�---___- 4 Number of lines________�`--_____.._ _____Length of each line-.Z_.5`d-_.fn-6--__.Width of trench_.-.__.�____ ___________________ Type of filter material___ _V_kbepth of filter material _-- i.________Total length__ ____l f�__j___________________ Q Seepage Pit: Distance to nearest well----------------------Distance from foundation-.,................Distance to rr�earest lot line----------.-__-.. ❑ Number of pits----------------------Lining material-------------..........Size: Diameter---------------------.Dbpth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_____________ Lining matel•ial__________.________.__.______-_-_- - f I ❑ Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. f Privy: Distance from nearest well------_____-------------------------------------Distance from nearest building-----------._________________________..__. ❑ Distance to nearest lot line--------- ----------------- ----------------------------------------------- Remodeling ---------------------------------------------Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------------•---------- ------------------------------ . I hereby certify that I have"prepared this application,and that the work will be done in accordance.with San Joaquin County ordinances, Sta laws, and rules_-and -ations of the San Joaquin Local Health l�istricf. (Signed)--x------ Ems[u 11_ .- �-------- - ----------------------------------:.-k and/or Contractor BY :_..... - (Title) - ------------- -- ------- size --- - (Plot plan, s owing size of lot, location of system in relation to wells, buildipgs, etc., can be placed-on reverse side). , FOR DEPART NT165E ONLY APPLICATION ACCEPTED BY--.,L -- --------- --- - ---------- --- i A DATE REVIEWED BY ,--- ----- -- --- -- -- J « DATE " i_ - ti.A Alterations and/or recommendations: ' ----- DATE = - ------- - ----------------------------- BUILDING PERMIT ISSUED----------------------------------------------------- . - -3 f f ______--------____________________________________________________ - ._ _ _ ------------------ - _ _ ______________________ ____ _______a__.-__________________________-.______-----_____----___-_-_ __.-_-.- __-_ -------•- ---------------------------------------- -----` I ---------- ' ' - -_._ . ---------------------------- ---- ----- .-_------ --------------------------------- -------------— _ ----'--- ------------------------------ ------ FINAL INSPECTIO ? { -- ---------- --- Date------ �~�� ---------------- 01 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stieat 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California - Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P,Cc: