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APPLICATION FOR SANITATION PERMIT Permit No. .l��.lzr� (Complete in Duplicate) � Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS A D LOCATION.._ _ �O____ _ Owner's Name----------- ) 1 ------ ----------- - --- ----- -- ------------------------------------- --------- - ------------------ -- Phone_------.......................... Address _ L..rCl-0 y} ----_-•----------------•------------------------------•-----•-----------------------------------••---- ----••-----------------•--- Contractor s Name------ - ------•-,-"------ 1' f ' `' — -•-------------- ------._. Phone------------•------------•--------- ' Installation will serve: Residence [Apartment House ❑ Commercial I] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms ---.,--Number of baths ____1__ Lot size,A�,Xfl��------_------------------ 11 Water Supply: Public system Community system ❑ Private [I Depth to Water Table__ ft. Character of soil to a depth of. feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe I��Hardpan ❑ Previous Application Made: Yes4 No M-- New Construction: Yes �No ❑ FHA/VA!Yes ❑ No R�-- TYPE OF INSTALLATION ANDS SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.-_; a____ Distance from foundation__. __f Material__. P .------d ---c- ----__---_. No. of compartments--------2-------------Size--------_`,�___Ys`7:Kf-----Liquid depth---- �7�- ---------Capacity--k44 ---- 70 Disposal Field: Distance'fromilnearest well_--- -.._y---._Distance from foundation--/ ----------distance to nearest lot line-L5___-___..__. Number of linos------------2-----------A_____Length of each line_---___y15 ___,-------.Width of trench------%�Z------------------------- Type --`________________Type of filter material---_.e-TP_Chf------Depth of filter material----- _r------------ otal length--------Ida______--------------------- IISN Seepage Pit: Distance to nearest well____-__-__Distance from foundation_____ D'istan'ce to nearest lot ®� line_' �_______ Depth-Number of pits--------1------------Lining material--- ----Size: Diameter----- ---f'--. . - - -- l ------ --i Cesspool: Distance .from 'nearest well _-_--a__.-------Distance from foundation.-- 'Lining materia__._---___..___.____________________ ❑ Size: Diameterl------------------------- _.Depth------------------ k-r . -- �--:"` '--------Li Liquid Capacity . i 1 it { G P Y gals. Privy: Distance-from nearest well__.._,i- ---------------------_____________._ (bis#ahce from nearest building-----__---_____________-____________.__._ 1 Distance to nearest lot line____ � . li ° Remodeling and/or repairing (describe):-------------------------------- --------� ----•-------------- =i I ---------------------------------------------------------------------- ------------------------------------ ------------------------------------------------------------------------------ --------------------- •------------------------------------- µ e y I hereby certify that I have prepared this application `anis'that the work.will be done in accordance with San Joaquin County ordinances, State laws, andr s d•regulations,of the San Joaquin Local Health District. I (Signed) -------------- -------------- --- ----------------------- -0 _ (Owner and/or Contractor) -----'------------------E------------------------- ------ --------- --- --- ------- Title i (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- DATE (A ---------------------------- REVIEWEDBY--------------------------•--------------- --------------------------------------- DATE J-------- -------- ---------------------------------•- BUILDING PERMIT ISSUED - -------------------------------------------------- DATE---1---------- ------------------------------------- Alterations and/or recommendations-------------------- -. ------------------------_-- ------------------------------------ FINAL INSPECTION BY______ ________ fit ---•-- -•- -- - -- ---------•--- . Date_------------•• - 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-4-2M ReV'Sed 8-'54 F.P.Co.