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APPLICATION FOR SANITATION PERMIT Permit No. -__-- 1_ __/ - (Complete in Duplicate) Date Issued ----- 6_XI 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 Ord' ce No. 549. J08 ADDRESS AND LOCATION_ ------------- . -----------•---------------------------- Owners Name------ �,/ - ;---------- ------------------------ ----------------- Phonef/_Q„ c -------- ... ^ Address--------------- ------------------------------------------------------- Contrac'tor's Name------------- -------------------------------------------- ". `. '" -------- Phone. =' Installation will serve: Res'dencelB Apartment House ❑ Co mmeicial ❑ Trailer Court ❑ Motel ❑ .Other ❑ 1 i Number of living units: -_ -____ Number of bedrooms --- f S– �•, t. /-- Numberr of baths --�---- Lot size ---%-5—_�-�'--�Q,---------------------------------- Water Supply: Public system ® Community system ❑ Private ❑ .:Depth to Water Table 0s0__ ft. ' Character of soil to a depth of 3lfeet:_.Sand ❑ Grl❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91 Hardpan ❑ l' Previous Application Made: Yes ❑ No ® New Construction Yes ❑ No K FHA%VA: Yes ❑ No r TYPE OF INSTALLATION AND*SkCIFICATIONS: �"` , (No septic tank or`cesspool permitted if pub is sewer is available within 200�feetj t t a. s Septic.Tanlc: Dis+ante from nearest wel#- __ - _Distance from fo \dation,-,/Q__.___---Material---__-_: i Q Qk ` ' i -------Siz '= � ® No. of cbmpartmants___---. ,--- eg ' "`_ i fquid depth_--- -----------^,_-_Capacity A-�T1 ,(E, Disposal Field: Distance from nearest•well - -[7WDistance from foundation_-_;�Qt/___ADistance to nearest lotne____-__ __-- ® Number of lines---------,C__ Length",of each line-----_ _, NI-Width oftench--�_ Type of filter material-- _(/meq Depth of filter material--v-—1..1 Total length_----___ -- Seepage Pit: Distance to neare� well -- --__-? /:' Distance from foundation-..,_Q __ Di tpnce�o nearest lot line__- -f-- Number of its_-'--I g i �---.Siz:Diaarrr&e t_-_�-- Depth'----- p rr--__ Linin materiaL_, 'B Cesspool: Distance from nearest well-----_--_-_L Distance from foundation-___e----__--_-.Lining material_--_ ___--_-_ i -- ----- x ❑ Size: Diameter ---- --- --- - =Depth--------- ------ -------- ► L -- r.:-Liquid Capacity I-------- gals. Priv "'I -1-1 [' " f art y= Distance from nearesh well . _ ,�—�-_, ----------------------Distance from ne ares _ + building_-_--. _--___- t+ -- ----- ------ --- .El Distance to nearest lot line-__ _--_-_-__ .,l - 1 Remodeling and/or repairing (describe)------------------------------------------------------------------ ---- -------------- Gt t --- 1 I r------------------- - ------------------------------ ---------•- I - _ # - ''". 1 hereby certify that I have prepared this application and�fhat the work will be donE i,i accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he'San Joaquin Local Health District. 4 ' (Signed) - f . ?-------------------- P1 By:------------- (Tit } , ne n r Contract w d/o Contractor) w r Ie ------------------- ------------------------ - (Plot plan, showing size of lot of system in relation to wells, buililings of ., can be placed on reverse side]. t FOR DEPARTMENTj.USE ONLY( APPLICATION ACCEPTED'BY_- - ----------- - ----------------------------....I ( +DATE-_.__� . ------------ -- ---- ------ REVIEWED BY ---------------------------------- - ---- - ----- 1---------------- ------- #= f y DATE-. l -1 s fr r. --- -�--------------------------- BUILDING PERMIT ISSUED- ----------------- --------- �''"` ----------------- DATE----- -- -- +erations and/or recommendations: -"--"""""-- ^�^-^ f -------•--------------------------------------------- w --------------------------------------------------------•-•--- -- --------- ------•------------------•----- ------ ---- --------i----------- -------------- -- ---- - - FINAL 1NSPECTI y Date / � w 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---9-2M Revised 1-57 F.P.CO.