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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __�_1/ .G.. This Permit Expires 1 Year From Date Issued 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 ,�� % d �iG/ � -- , /� 1 - ------- Owner's Name Jl�'X�I -----------------•' - Phone Address ' g f - --------- --------------------------------------•------------------------ Contractor's Name- • --- -- --- ----- --------------------- -"�-------. Phon"7f-2 --Q�-~------- Installation will serve: Resid nce [] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I_____ Number of bedrooms __Y-__ Number of baths -____ Lot size ----------------- ----..______._.__ Water Supply: Public system jX Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes ❑ No)CI FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) �f Septic Tank: Distance from nearest well--- _-Distance from foundation__/a_________.-Material- iG�---_---- % No. of compartments_-__L__________________Size_ _+,t__ 1__'b____:___Liquid de th---__ __..____...._ Ca acit }io 1� q p. p ---------------------- Disposal Field: Disfance from neares well r#V._____Distance from foundation_210_--______. istVice to nearest lot line_ _______-__- Number of lines_______ ___ --------- ____ _ __ ____Length of each line�_ � _ __Pith of trench-_�,4_`--_ ` ---------- --Total length___�,AW__ Type of filter materia ,.. -Depth of filter material___`_$-<< ------------------------------ Seepage Pit: Distance to nearest well__.Z0.b--------Distance from f undation___3_!0_.__.__.Distance to nearest lot Iine_4.......... Number of its__ _ ' __Linin materia Size: Diameter- !!_.___.__.De th_1. -____________________ Ces�ool: Distance from nearest well_________________Distant e from foundation--------------------Lining material ____________________________________ ❑ Size: Diameter--------------------------------------Depth---•----------------- ------------------ - -----Liquid Capacity- ------------------------gals. n Privy: Distance from nearest well __..-_------- ----------------------------------Distance from nearesf building____.____---------_____________--___._--. 1r'� ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---�_ p --- 4--------------------------------------------•-------- ------------•--••------------------------------------------------------ ------------ ------------•--------------- ---------------------- .r - ---------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------- I 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 ules and regulations of the San Joaquin Local Health District. (Signed)--- ---- __ ___---_____(Owner and/or Contractor) m By: --------------------------•--------------------------------------------- -•---------------------------------------(Title)---------- ------ ----------------------- --I--T- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), oe FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE_/Q_--_?_ '6(7_ REVIEWEDBY----------------------------------- ------------------------------------------ ------- --- -------------------------------- DATE----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations---- --------------------- --------------------------------------------------------------...----•------------------------------------------------------------- ' ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ----------- ---------------------------------------- --------------------- ---------------------------------- -------- ------------------------------------------ -- ----------------------------- FINAL ----------------------- FINAL INSPECTION BY: --------------------- Date--- ~' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton. California Lodi, California Manteca, California Tracy, California ES-92M Revised 6-'59 F.P.Co.