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FOR OFFICE USE: -- - -- -- - ------------------------------------------------ --------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) --- ----- -----=------ ------------------------- - This Permit Expires 1 Year From Date Issued Date Issued ._-- 1Z I6 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 Ordinance 49. JOB ADDRESS AND L C TION ............... _ - -------- ' ---- Owner's-Name ------------ ---- -�TAddress- � - -- --------1------ ------ ---•--------------------------------•---••------------•-- Contractor's Name----------------------- --- -- - . ' __f ---------------- Phone .............................. Installation will serve: Residence Apartment House ❑ Commercial ❑! Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ -_- }Number of bedrooms _- Number of baths __ .___ Lot size ..___ l� Sys -- -_ ------------------ Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,,,/ ft. Character of soil to a depth of 3 feet: Sand I7 Gravel 1"1 Sandv I nam F-1 (-.1— 1 17-1-i r -i_.: 1, A J_1. . rat � Previous Application Made: (If yes,dpte_______________--- _j ' No ❑ Naw Construction: Yes ❑ No �HANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .10 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I - qe }i Tan : Distance from nearest well_-' ---- _____---- Distance from foundation -------------------- Material --___--___._----_.__-___.._ --------------- •--- No. of compartments - Size -----------------=--------------Liquid depth --------------------------Capacity-------- = A Disposal Field: Distance from nearest well Disf8nce from foundation .____1_a__ -.___.Distance to nearest lot line___ �1____ ®� Number of lines' -_____ _- l -- - ------ Length of each line ---------------Width of trench.-__.__--- � / Type of filter material__ �- _ - Depth of filter material__ �,i��_-.-Total length______________ ' Seepage Pit: Distance to nearest,well-________________"_Distance from foundation -------------- _____.Distance to nearest lot line ----------- ..__.. ❑ Number of pits- !------------------ Lining material ---------- ------------Size: , Diameter---- --------- --------.Depth--------------- •----------- Cesspool: Distance from nearest well-_ --------- _---- Distance from foundation ... .---------------- Lining material ------------------------------------- EJSize: Diameter ----i ------------------------------------ Depth----------------- ----------------------------------- Liquid Capacity------------- - - --gals. { i Privy: Distance from nearest well__'.--._______________________________________Dis#ante from nearest building------------------------------------------ ❑ Distance to nearest lot line -----------------------------------._-------------- _ Remodeling and/or repairing (describe):__________________ 1 -____.__._ c -------------------------------- 1 4 -----____________________-------------------------------------------------------------------- --------------------------____________------------------------ ____________ - . __ _____ _ __ _ ___________________________________________________________________________________________________________________________________________________________________________________________ I hereb certify thaf I have prepared this application and that the work will be -done in accordance with San Joaquin County ordinances, s; and r s and regula tionsthe San Joaquin Local Health District. (Signed) - - ------ Owner and/or Contractor) ------------- Br �-E -- Title `R ( } (Plof plan, showing size of lot, location of system in relation f (wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- C-_ . -........ �r DATE -------`1�_-1 _`_��-� ------ IEWED BY------------ ---------------------�------ -------------- - - . ----._ DATI_..--------------------------- ! DING PERMIT ISSUED ----------------- -.--------- DATE.------------------------- ----------------------------------- Alterations and/or recommendations ------------------- ----------------------------------------------------- •----------------------------------------- ...------ ---------------------------------------------------------------------------------------------------- ---------------- ----------------- --- ---------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: --- 4C,,-.0,iat-rz-t. �Da}e---------- -` -(Q.� A. ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Street 124 Sycamore Street 205 Wes! 9th Street Stockton, California Lodi, California Manteca, California Tracy, California E6-9 17EVi6EO 9.59 F.P. Ei a. 2M 6-60