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APPLICATION FOR SANITATION PERMIT Permit No. ....................... U ! (Complete in Duplicate) _ Z This Permit Expires 1 Year From Date Issued Date Issued ..�---------------- Application is hereby made to the San Joaquin ,Local Health District for a permit to,construct and install the work herein described. p This application is made in compliance with County Ordinance No. 54_9. J,7 { JOB ADDRESS AND LOCATION_ �".vil-- . ~� , �"�" r ----- -------------------------- >k ---------------------- Owner s Name - -•----- .._____..— ..:�-.--�--phone.,--------- - 571' Address-- - - S4: +s `---------- /1. ------------- 1 0--------------- Contractor's Name-- -----------� _. ------------------------------------------------------------------------- -- --------- Phone...------------------...---------- Installation will serve: Residence $] Apartment House'[] Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living:u itst.--- Number of bedrooms' z- Number of baths .-. _. Lot size ...... `G Water Supply: Public:system. ❑ Community system:,❑ 144ydte ❑ Depth to Water Table ,;�U. ft. + Character of soil to a depth of 3 feet: Sand Gravel'E] Sandy LoamClay Loam Clay ❑ Adobe Hardpan ❑ Y Previous Application Made: es`❑'1"•No New^Goi'sftuction- •Yes-[v]fNEl Yes ❑ No ❑i � i Y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank+or cesspool permitted if,public sewer is available within 200 feet'.) z Septic Tank: distance from nearest well. a.-....Distance from foundation_.._/'P..:�&Materriial .j'f!---------------------------- r p � Size-_xz--X--3 -------Liquid depth T --------Capacity �-� Q No. of r.om artments_-_.....-�- � -. Disp aI Field: Di'ttance from nearest w IL-t-.5= ----Distance from foundation..../�------.Distance to nearest lot line... ........... ± N�mbar of lines------: --- Length of each line---.-_ ®-- --------Width of trench.------ �• material Type of filter material__-.. ._....�G ..Depth of filter -.-,l _I'.,� Total length..:.-4.0-...._.._. ._- - �• Seepage Pit: Distance to nearest well_____.-i�"'"----D-istance from found`ation'-`_'- ----------Distance to nearest lot line................. ❑ Number of pits.-'_--- ---------Lining material---------- --------- Size: Diameter------------- ---------DepW - -- -------------------------- Cesspool: bistance from nearest well------------------Distance from foundation-------------------.Lining material--------------------.------------...._. Size: Diameter--------------------------A_�- De tli .. -----------------Liquid Capacity t--------------------------gals. Distance to nearline--..--.-, ._ ......- t ' ❑ � r--._..nearest I ale------------------------- � --------_-.-q.:_Distance from ne rest buifdin9-i----'�---�--------------------------- I Priv Distance from n Remodeling �and/or?repairing (describe):------------- - ----------------- ----------------------------------------- E---------------------l---•------------------------------ 1 ' i-----------------------------------------------------=-------=---- ----------------------------------------- ------------------------------------_- ----- ------ ------------ --------------------------------------- ) I I §} -----'-------------------- -------------------------------------- 1t E s i T } a `; ;: s------------------ i---- 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 rule's and regulations of the San Jobquin Local Health District. 5i ned� -•-� �- ---- ---��- --------------------------- - - ---- - ---- - --- - -- ------ - (owner and/or (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pl - ........-----------..........__ BY= .....- •------ (Title) aced on re Terse side). J i 1 r _ I FOR DEPARTMENT USE ONLY ! _ f f APPLICATION ACCEPTED BY-- REVIEWED BY i - - --- - DATE- --- --- --1------- -- ----- --- - ---------------------------•-----•------- DATE------- - - BUILDING PERMITSSUED.-._ ..... - --------------------------------------- DATE ------------------- ----------------------------•----- Alterations and/or recommendations:---- ___--" _..`e—�x.=•-- -- --� ------------------------------------------ -----------------------------• ----------------- ---------------------------- - -- - ---------•---- ------- -_-•----••---------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i FINAL INSPECTION BY:.(f t Date7:"_`. ------------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F-P.Co.