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APPLICATION FOR SANITATION PERMIT `Permit No. I (Complete in Duplicate) 3 This Permit EX13ires ] 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 This application is made in compliance with County Ordinance No. 549. work herein described. 4 JOB ADDRESS AND'L CATION.________ Owner's Name_________ _ _. --------- � lQ Tfd�' ----------------------•--------------------------------------•------- -- _IJ__,C?.�_ -- ,� Gtr --------------•---------------------- - --------------------------------------- Phone Address---------------•----• Ser4ljy• Contractor's Name-:-------- = G1_ / l-e"711 I ------ - -{'- ------------------- Phone_.-- . - - - -----•-----------•------•------ - ------------ ------------ - -------- ---------•-••---- Installation will serve: Residence [ ,Apartment House Commercial ❑ �/ ❑ ❑ Trailer Court ❑ Motel ❑ Other i Number of living units: �__-_ Number of bedrooms ----Z—Number of baths _1____ Lot size Water Supply: Public system L1C:ommunity system ❑ Private ❑ Depth to Water Table�917t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Adobe Sandy ❑ Y ❑ Y ❑ ardpan ❑ Previous Application Made: Yes ❑ No ❑-�Pd€w-Construction; Yes ❑ No �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 Disposall Field: Distance from nearest well'_______________Distance from foundation___-..--------------Distance to nearest lot line•___-_-____.__-_- Number of lines-!------------------------------- Length of each line------------------------------Width of trench----------------•-----------_- Type of filter material_______ _______ --------Depth of filter material-----------------------Total length-----------------:------------------------ -- ----------_-- \ , ------ D Seepage Distance to nearest well------- -----____Distance from foundation_Ae--�______.Dista�ce`to nearest lot li�_�_�_______ [ Number of pits..:._ _____________Lining mafierialv u e. ----Size: Diameter-3-3__------ De fh •Z P5------------------- -- I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- I--] Size: Diameter--------------------------------------Depth----------------------------------------------------Liqu+d Capacity--------------------- -----9 els. Privy: Distance from. nearest welL_________________________________ Di _______________ stance from nearest building-----._--------------------------- - ❑ Distance to nearest lot line------___-______________---- _________ _ � / / -------------------------------------------- ------------------- / repairing 1:___ f �lar Remodeling and/or re airm describe _____. ----------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed)---------------------- ------ J _2.fix/' ---`--/---------------------------------------------------------------------------- ---------------------•--------•-•--- _ _ �� (Title caner and/or Contractor) I - o or) (Plot plan, showing size of lot, tote+i i f syst40t_ m in relation to wells, bup s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONy ACCEPTED BY - ' . ' --------------------------------------------------------------------- DATE--------� REVIEWED BY '' `` --------� -------------- ------ ------ ---- ------------------ -- ----------------------- ---------------•---------------------------------------- DATE------------------------------- BUILDING PERMIT ISSUED--------------•--�-----_----- - ------------------------- ------- ------------------------------------------------------------ DATE----------------------------- ------------------------------- Alterations and/or recommendations: ----------------------- -- ` -; ---------._------------------------- -----) --------Dry_-�Tr-,t_..____'Z�-------��_ —, ��R_1�3�__-----.._.__--/ - --_Z---q_ ��''---------------------------------------------------------------------- .--- -------- ------------------------------------------- ----------------- - - r--------- { !f --- ------ ------------------------------------------------------ FINAL IN'S'PECTIONB �..c Date fs' "- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Str*et 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59.F.P.Cu.