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APPLICATION FOR SANITATION PERMIT Permit No. .--lZ�_ ,t \ (Complete in Duplicate) i • This Permit Expires 1 Year From Date Issued Date issued __�l�._ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. y This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------- -------------------------------------------------------------------------------------- 4 Owner's Name-------------------------------------- 3 _AlOn o--•-•-----------------=------------------------------------------------- Phone-------------'-•"-'----------•-------- `w Address---- ----- ---- ------ ------ ------------------------ -•-------------------------------------------- Contractor's Name---TAA_ _-A NIC i`f' ip �i:�czik__ser3 cep ____ Phone _A' D 6_______..- Installation will serve. Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: A____ Number of bedrooms ------?Number of baths _A___ Lot size --- or..x---12,Ql-.__•____________________________ Water Supply. Public sysfemlg 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 g Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes ❑ No I FHA/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 ___-_-___________.------------------_--------_. fisting No. of compartments------------ -------------Size------•-------------------------Liquid depth---------------- Capacity.--•------------------- :.'�• 4�. f Disposal Field: Distance from nearest well---Na7i01t....Distance from foundation---10!--------..Distance to nearest lot line-----5--------- j-,r t t Ing Number of lines___-___�___-____________________Length of each line------3Q-------------------Width of trench------ " ��r- ----------------- F` & ADD Type of filter material___epe_..Fk.__Depth of filter material----10______-_-.Total length------------------------------------------ Seepage _--_--_--- _________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.-__________-- FbBkting Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- F-1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------- -----gals. Privy: Distance from nearest well __________________------------------------------Distance from nearest b0cling--------------------------------- ....... ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------- •-------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- SUPPLEMENTARY --------------------------•--- ---------------------------•--------------------------------------------------ST7� 'I'BRY--I�AIN�GE 0-----------------------------------------------------------------------------"- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------"----------- ------------------ -------- --------------- ------------------------------------------------------------------------------------------------ ------- - 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. I Si ned _Tb1ft__PAY--A__NIG1�3T_Sagti-G---`rank $Ireln --- -- -- -- -----------------------------------------------------(� Contractor) BY:------------------------------------------ -- --- -------------(Title)---------- ---------- - ----------------- ---------------------- ----------------- --- -- -------------- (Plat plan. showing size of lot, location of system io wells, buil gs, a ., can be placed on reverse side). FO DEPARTMENT Cgi ONLY APPLICATIONACCEPTED BY------ h`" ""-------------"--------------------------------------------- DATE------------------5. --_A -44__0--------------- REVIEWED BY------------- ------------- DATE - ------------------------------- ------------------------------------------- BUILDINGPERMIT ISSUED---------------a1=-----------y--------------- ----------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:_------------ ---------=----- ------ ---------------------------------•--------------•------------------------•--------------------------------------- u w w. f. •,, -------------•-•---------------------------------- - ----------------------------------------------------------------- ---------------•---------------------------- --------------•----------•------------ -------------------------------------------------------------------------------- -------------------------------------------------- FINALINSPECTION BY:----- ------ ------------ ---- 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-9-2M Revised 8-•59 F.P.Co.