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Permit No. ------ APPLICATION FOR SANITATION PERMIT y� (Complete in Duplicate) `r . This Permit Expires 1 Year From Date Issued: Date Issued _-.(.. ..b Application is hereby made to the San Joaquin Local Health District for a permit to constru in it th work herein a ib This application is made in compliance with County Ordinance N 49. r Ili JOB ADDRESS AN~ LOCAT19N._:----- __ r Owner's Name �I�' 4 "��Phone_ _ _�V_IP II, / - Address-------------------- ..X- s�7?/AE �-�' .............. ---- p w------- ---------------- --- -------- {i 'i Contractor's Name--------- - - �_` y f�'� fs-Phone ~_.._ Installation will serve: Residencepp� Apartmenf House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living unifJfl __.1____ Number of bedrooms ._.?- Number of baths _l____ Lot size ________________________________ Water Supply: Public+s sternp Community system Private De th•to Water Table ft: Y l�l� Y Y ❑ ❑ P Character of soil to a depth ilof 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay,❑ -,Adobe j4 Hardpan ❑ Previous Application Made: 'fes ❑ No X New Construction: Yes� No ❑ FHA/VA: Yes❑ �NoX TYPE OF INSTALLATION ASND SPECIFICATIONS: l x (No septic tank or cesspool permit#ed if public ewer is available within 200 feet.), i pti Tank: Distance. rom nearest well-__��__.___Dista r} ar'from/fo�unglation==Ac!_______._..Mat fal_/- edn Se _ No. of compartments- -_ --------------Size- Z---------Liuid de th____--�--________-�aacit Disposal Field: Distance,',from nearest well__ _ _ Di��a�4e ro founda ��} ____ ___.Distance to nearest Igt line________________ ' 5Sr' o� Number of lines___ -- __ -- --Length of each line----- ---- ----!f_ ------Width of trench- r_____.--------------------- Type of filter m tea `rial_- --_____ Depth of filter materiel___f'____._______Total length___._________________ i -----y Seepage Pit: Distancetto nearest /well__ "-_Distance fro fo dation_-__` -________.Distance o nearest IQ�lipe___--___.-_ Number'laf pits__-.-_-/_J� _-__-_Lining material.d ��i�-Size: Dia meter---a�X/43.___.Depth'_..! __----------------------- Cesspool- ______________________Cesspool: Distance;lfrom nearest,well--------------�_-Distance from foundation--_-__-___---__-__.Lining material__F__.._______________________-__. Size: Didm` eter-------------- --_i De th-------------------------------- == Liquid Ca acit als. ❑ P g P Y ----- 9 Privy: Distancelfrom nearest well---------- ----------t'c'"_____________Distance from nearest building--------------------------------------- .-. p� ❑ Distancelto nearest lot!.Iirae-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------- --------------I----------•------------------------------------------ -------------------------------------------------------- ------------------------------------------------ 4!-----------------------ii..- k = - r ----- --- -- --------------------- ------------------------------------ ---------- -----------------• -- •=------ ---------------------------- ----------------------------------------------------------------- ----------------------------------------------------------------------- 1 I hereby cer#ify that I,h ve,prepared jhis application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and 'rules nd regulation of the San Joaquin Local Health Dis#rict. �' f1"`" -_ Owner and/or �$ (Signed]--------- -----------------------= ---------- ------------ - -------------------- ----------------------- - --- - ----- -- - - ------ -� / r Con#rac#or) L. -------------------------------------------------------- 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_ -F �1' = - ------ DATE- - - /_,_. t BUILDINGPERMIT ISSUED-111----------------------- -`-------=--------------------------------------------------------------._ DATE------------------------------------------------------------- 11.and/or re commendations:--------------- -- ------ -------------------- -------------- ------------------- 2 ------------------ -•--- - --I*-- -- ----------------------------- --------- = - -------------------------f�-�---- ;Ip FINAL INSPECTION BY:. 4 Date------ - -------------------r ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street i 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.CD.