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APPLICATION FOR SANITATION PERMIT ' Permit No. Z_ ; � ( S (Complete in Duplicate) s U_ Date Issued ____________ 1 1 2, 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. JOB ADDRESS AND LOCATION------ l ---- ---------� --- 1 --- [� --------------- Owner's Phoney ev Address = -•t.�-—--'------------------- ---��!�� - . � z Contractor's Name- _�-------------- 1` "a . ,...----------------------------------------- ------------------------------------- Phone------_-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ ,Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J.___ Number of bedrooms ___/_ Number of baths ___,/__ Lot size __.__7 __L _ _f__.______________ Water Supply. Public system ❑ Community system ❑ Private Df Depth to Water Table d--5_ ft. Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam U Clay Loam ❑ Clay ❑ Adobe❑ Hardpan (] Previous Application'Made: Yes [-❑ No New-Construction: Yes ❑ No QQ FHA/VA: Yes ❑ No [4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___•�70---____Distance from foundation___L_O-r------..Material_ ____________- • � -No. of compartments_____,__o�------------Size43---A__5_-4-- `------Liquid depth__-fV-----------Capacity.-- Disposal Fuld: Distance from nearest well---S_LJ------Distance from foundation____ 40 -_.Distance to nearest lot line._ 6._...... ? 11i Number of lines----------- __________________Length of each line______cS�'_ _7--------Width of french....9_ --------------------- Type _��____________- Type of filter materia4.0 4 �f, '_Depth of filter material_-_�s�_____________Total length_______-12-- _l N Seepage Pit: Distance to nearest well-___________________Distance from foundation--------------------Distance to nearest lot line_____.__-_:____-. ❑ Number of pits---------------------Lining material----------------------.Size: Diameter--------------.--------Depth-.-.----------------------------- Cesspool: Distance from nearest well--------------;__Distance from foundation--------------------Lining material_____________________________________- ❑ Size: Diameter------------------ ---------------Depth----------------------------------------------•-_...Liquid Capacity................... gals. Privy: Distance from nea;est well----------------_- -----------------.----------Distance from nearest building----------------------------------------_ ❑ Distance to nearest lot line-- ------ ---- ------------ ----------------------------------------------------- --------------------------------------------------------- Remodeling and/ r pairin . {descrit�e):_ =\ _,_ J_ r+,�!_ __._ _ -.r �� 'F _-__---.-- � _ ---------------------=------------------------------------------- ----------------------------------------••-------------------- -- ------------------------------------------------------------------------------ -- I hereby certifyffhat.l 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. (Sign ------s-- -- --- --;.' ! ------ `f --------------------------------------------- ed) (Owner and Contactor] By:----------- f -------------------- -------------------(Title)-------------.------ . ---- .----------.. ------------------------------------ --------------------------- (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 Cv� L' -t7=T�' r� ---------------------------- DATE'--,��- `Z -- -------------------- yREVIEWED BY--------------------------------------------- -------------------- --------------------------------- ---------•------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------•------------------------------------.- DATE-------------- ------------------------------ --------------- Alterations and/or recommen ations:------------ ---- ---- ------- -----,---------------------z------•-------•------------------- --�------------------------- --------------------- --------------- FINAL INSPECTION BY:-- ----------- ------ -- Date-------------------------------------------------------------------------------- AN JOA UIN LOCA EALTH DISTRICT I30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ock+on, California Lodi, California Manteca, California Tracy, California �. FS-9-2M Revised S-'59 F,P.Co.