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Al�) APPLICATION FOR SANITATION PERMIT Permit No.._.l__� (Complete in Duplicate) _ /� y/- 4. L This Permit Expires 1 Year From Date Issued Date Issued ___ 1___{{___�1__. Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ---I/ _�� `--•--------------------------------------------------------------------------------------------- Owner's Name________ s- ` '2)VI-t l -I--- :.; Phone Address---------� s ...... Contractors Name________________________ ___ __ ti + r �� Installation will serve: Residence Apartment House E] Commercial E]'� Trailer Court p Motel. ❑ Other ❑ Number of living units: _ r _.___ Number of bedrooms -3.- Number of baths� : ___ Lot sizeD_._.___________________________ Water Supply: Public system [�G- y system ❑ Private ❑ Depth t6 -Water Table ft; f Character of soil to a depth of 3 feet: " Sand I]. Gravel ❑ Signcly,Loam-❑' CI y Loam [] Clay ❑ Adobe [�'ardpan ❑ .7 Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No 0' FHA%VA: Yes ❑ No E- TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / I c Sq�ptie Tank; Distance from nearest well-__=____________ Distance from foundation -------------------- Material ----- Y__ ----------------------------- ,.______._. No. of compar4nents----- - ------ ------- ---- Size -------------------------------- Liquid depth-_ --------------------- Capacity ----------------------- Disposal Field: Distance from nearest well --- _-7 —:__.._Distance from foundation ---- e_ --______Distance to nearest lot line_4+__!--_- O�i1?d Number of lines______'-__-_ �,---__Length of each line_____4T_� t= Width oftrench_.._._��_____________ Type of filter material_ '_ y_Depth of filter material__��___.__i_Total lerigth-__.___----____________________ Seeppge it: Distance to nearest well ------------ :.......... Distance from foundation ------- Distance to nearest lot line_________________ W Number of pits.-------------------- Lining material ----------------------- Size: Diame_ ter--/=:'---,-------' -- Depth ---------------------------------- x, V Y ---•Gesspool:_ .,..Distance from nearest -well------- from foundation ----- ._.---------- Lining ❑ • J`--' ma.te�rial__ �______________________________ Size: Diameter.___ -------------------------e�th-�------"--- T- =- Capacity - '---------------------gals__ . f Privy: Distance from nearest well ------ _------- _--------------------- _--------- ___Distance -from nearest building --------------------------------- --------- I ❑ Distance to nearest lot line ------------------------- ------------------------------------------•---------------------- ------- Remodeling and/or repairing (describe) ------------------- 1 ---------------------------------------------------------------•-------------------------------------------------------• ----•-------------------------------- - -- ------------------------------------ ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- I hereby certify that'l have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules arid regulations of the San Joaquin Local Health District. 5i ned ( 9 ------------------ - --- --- - - - - - -------------(6w r Contractor) -------------------------------- ----- By: ----------------------------------------------------------------- ------ -- ---------- ------------------(Title)-,- ------- - ------ _-- ---- --- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY ---- -------_-----.fl• -------- DATE ------ /�7,/Z�%-------------------------- - REVIEWEDBY ----------------------------------- --------------------------------------------------------------------------------------- DATE ----------------------- BUILDING PERMIT ISSUED ------------------------ ---------=------------------------------------------------------------------- DATE------- ---------------------------------------------------- Alterations -------------------------------------------- Alterations and/or recommendations___________________________ --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------ --------------------------------•----- ------1 --- ----- ------------------------- --------------------- -- - --- {----------------- ..... - ----------- ------•---------------------------------------------------------------------------------------------------- I FINAL INSPE ---------- ------ - -- -- ---- Date ..... 1_1!5__ 6.0----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300_West Oak Street 132,Sycamore Street 814 North "C" Street r Stockton, California ► Lodi, California '�1` 1 hAantee , California R: " A Tracy, California FS -9-2M Revised 6-'59 F.P.Co.