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4� APPLICATION FOR SANITATION PERMIT Permit No. ..1�g.�2" (Complete in Duplicate) / Qate Issued ---1-��--- This Permit Ex fres 1 Year From Date Issued Applicat'son 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 C unty Ordinance No. 549. e-vJ- -I r 2oo-53 �� o JOB ADDRESS AND LOCATION � ` ►'G``'--- -'� 1 '--------------- ---- Phon Owners Name-----___ ---------- er. I�� Address__-J d-'_---,9111 ------?-- 5-•--•------ --- •---------------------------------------------------------------------------------------------------•------------------------ Contractor's Name.._ Phone----------------------------------- Insfailation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /------ Number of bedrooms _ ___ Number of baths J------ Lot size -_A-A� _ ---------•---------------------------- Water Supply: Public system ❑ Community system ❑ Private, ] Depth to Water Table !p__ ft. n Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Not New Construction: Yes-P No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material_-_.-_-._._.---_--.--_-.-.___-- ❑ No. of compartments-- -----------------------Size------•-------------------------Liquid depth---------------- ---------Capacity Disposal Field: Distance from nearest well_- d Distance from foundation.-1_d-- -_.---Distance to nearest lot line Number of lines---.-_---� --- -------------- Length of each line__J_�.v---------------.Width of french---0�f---.--------------------- e� Type of filter me of filter material_ -__-_____._Total length_. '____--------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_-._----_---_-_-_ ❑ Number of pits------------------ ---Lining material---------------------.Size: Diameter-----------------------Depth..------------------------------- y Qistance from foundation____________________Lining material-------------------------------------- Cesspool: Distance from nearest well------- ._� EJ Size: Diameter-------------------------------------Depth---------------------------- Liquid Capacity- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.-------------------------- .------- ❑ 4 Distance to nearest lot line ------------ --------- ------------- ---------------------------•-•--------------------------------- ------------------------------------ Remodeling and/or repairing (describe)________________________ -- -------------------------- ----•----------------------------------------------------- ------------------------------------------------------------------------------------ ---------------------------------------------•---------------------- ------------------------------- - - --•- -------- ------------------------------------------------------------------------------------------ ------------------------------------- - ---------------------------- -------------------------- - -- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed)--_-_ (Owner and/or Contractor)!(s aT t (Title) c3P l _/Y! _ '- (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-- -...... f - ----------------- ----------- DATE--------------------•-------------------:----------------- REVIEWED BY------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------ - ------ DATE------------------------------------------------------------- Alterations and/or recommendations:-___-.--__- -- ---------------------------------------------------------------------------------------------- ------------------- Date - '-G� FINAL INSPECTION BY---- - -- -- --- -- -- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+rent 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised B-'59 F.P.Co.