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APPLICATION FOR SANITATION PERMIT Permit No-. {Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued -------__659' _ Application is hereby made to the San Joaquin Loca3 Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. JOB FADDRESS AND LCATIO ..._ F 1 - - Own6r's Name------------- ---- --r---- 'L� U47 -------------------------------------- -------- Phone#'.:._ :� �. Address . /._.__.. �-�/�lA/1___ ``� _�.fly eXt 4'72 ----------- -"Contractor's Name-------------- —/75W P/ / f/V "'-----•----------------------------------------------------------------•-- Phone!_1_-�_�__,�l _ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_____ Number of bedrooms _��_ Number of baths __1___ Lot size ________________________ Water Supply: Public system g- Community system ❑ Private ❑ Depth to Water Table-4-77- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay L] Adobe W Hardpan L]PreviSus Application Made: Yes ❑ No Z_ New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No X1_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticCCTank: Distance from nearest well________________Distance from foundation--------------------Material-----------.------.------------- ----------------- I GX+S-t7n7G No. of compartments--------------------------Size--------------------------------Liquid depth-------•--- --------------Capacity-----------•----------- Disposal Field: Distance from nearest well ________________Distance from foundation--------------------Distance to nearest lot line----------------- a �Y�StrrJC7 Number of lines-----------------------------------Length of each line-----------,-----------------.Width of trench_---------------------------------- �� Type of filter material---------- _-__________Depth of filter material----------------------- _ _ ______________Total length-______ ___ ________________----_----._. r r �, Seepage Pit: Distance to nearest well---_/YC _ Distance from[� foundation__�Q.._. �.�_-___.Distance to nearest lot line_�_._-.,__.-- Number of pits__-�1�'_�°__�fJ__Lining mate _ �_ _K._____ Size: Diameter, .............Depth_ '`..�. �.�-_--- -------- Cessltook Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________________ 0 Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy, Distance from nearest well-------------------------------------------------Distance from nearest building_____________.___-_--._-_-_____________-. d Distance to nearest lot line---------------/--- ---------------------------------------------------- Remi�deling and/or repairing [describe):-----_._ �7--I_ /-- /I�C� � a/ ,cq� �i ---------------------- ---------i----------------------------•---------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------••--••-----------•---------------------------------------- ----------------------------- il ----- -'------------------------------------------------------------------------------------------------------- --------------------------------------------- -------------------------------------------------------- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; State--aan rules and regulations of the San Joaquin Local Health District. (Signl�'d-------------r /,fT_ %1 /Y. f --- } b t" (Owner�a or Contractor) �� / , By-•----------------- ` � IAC-` ---`�-N-- ----- -------------------- {Title} = (Plot plan, showing sizf lot, location of system in relation to wells, buildings, etc., can,be placed on reverse side). :h !� FOR DEPARTMENT USE ONLY a 'r APPLICATION ACCEPTED BY---- --•--- (( -------- ---------------------------- DATE...lk�-------&-`•-- a REVIIIWED BY------------------------- --- DATE- ----------- -------- -- ----------------�--------- ------- •------------------------------------------------------- ----------------------------------------- BUILDING ---------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:------------------------------------- --------------------------------•----•-------------------•- -----------•------------------ I' .-'y- - - - ---------- i - ------- - - -- - __ ��-----------------------------------••---------------------------------------- ---- , ---- ------------ - ira -� -- -- ---- --- - � _ FINAL INSPECTION BY------- -- ---- ---------------------------------- ------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh 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 8-'59 F,P.Co. 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