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APPLICATION FOR SANITATION PERMIT Permit No. __'........_. e (Complete in Duplicate) Date Issued - =-// ___. This Permit Expires 1 Year From Date Issued Application is het!by�made,to the.SannJoaquin,Local Health District for a permit_ to construct and install the work herein described. This application is ode in Compliance with County Ordinance No. 5 9. _ ' JOB ADDRESS AND LOCATION-------------'�` ..... Z4_7tye�wp { Owner's Name-- 3--------:-------------------------------------C_1----1-,-I!-------• l l- �� (v_A 30_----:--------------- ---- Phone----••----4---------- Address_ f --------------------- 1� Contractor's Name---------• -------•---- -•------- ------------------- ------ ------------------------------------------------------------ Phone-------------••--•----•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___ Number of bedrooms __ .____ Number of baths __ _____ Lot size _______7 Water Supply: Public system ❑ Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil'to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamA Clay Loam ❑ Clay ❑ Adobe Q Hardpan ❑❑C Previous Application Made. Yes ❑ No 0_ New Construction: Yes ® No„R FHA/VA: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i _. S •nWeil--1- - Septic Tank: Distance from earest -_:_:-Distance from foun"dation__:_='Q___.___.Mat rias_ No. of compartments__._._------------Size____r3_ _` eL' ___Li Liquid de th__.___��______________Ca aci d �_.__- q P P tY - Disposal Field: Distance from nearest well----:!nrr--------Distance from foundation---..- ___Distance to nearest lot line.__ Number of lines---------------;2- ___ Length of each line----- .-_ ______.Width of french----- -4' ------------- Type of filter ma#eriaLA�_ - ---Depth of filter material---------f�-------Total length_____-___-______-f� ___________ Seepage Pit: Distance to nearestiwell__---- -------------Distance from foundation------------.------Distance to nearest lot line______.._______._ ❑ + Number of pits------- --------------Lining material-----------------------Size: Diameter.----------------------Depth--------------------------------- ti Cesspool: Distance from nearest well________________Distance from fou ndation--------------------Lining material___..________________.______._.____- C 1 Size: Diameter------- '----------------------------Depth-------------------- -- I ------- --------------Li `uid Capacity ----- alS. Privy: ; Distance from nearest _ well______ ___________ __ -------------------------------- - C _ ....� . .. .. Distance from nearest building----------------------------------------. i Fl Distance to nearest lot line--- --- - ------------------------------------------------------- f Remodeling and/or repairing (describe}:-------------------------- t ------------------•---•-----I-•-------•---•--------------A--•--------------------------------------- •------ r t # i, J t 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancis, Sfate laws, and rules and regu ions of the iSan Joaquin Local Health District. Si ned � ---- - 1•.r- � - { g r)--------------��-- ---- - ---- -- ---- -. - - � �"- � - --------------------- (Owner and/or Contractor) By:------------------------------------------------------- ------------------ ---_---------------,---------, f:, L_...(Title)....;------------------------------ ------------ - (Plot plan, showing size of lot, location of system•in?relafian +o-wells, buildings, etc.`can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•------------------- ------------------- DATE----------- 4- // � ---------------- REVIEWED ----- ------ REVIEWED BY--- ----------------------- ------------------- DATE------------ ,---- -- - ------- - - --- --- - --- ----------- ------------------------- ------ --------------------- BUILDING PERMIT ISSUED---------------------------------- -----• DATE.......................................................... Alterations and/or recommendations-------- ------ --- ---------------------------------------------------------------------------------------------------------------- ---------•------•------------------------------------------- ------------------------------------------------------------------------------=----------- -------------------------- -------------------------------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------- ! -----•----------- ----------- ---•- ,j __.i- _ ------------- ----------- ----------------------------- --•---------- -----=--------------------------------------------------------------------- r W FINAL INSPECTION BY:.. --------------- Date ---------------------------------------------- FINAL JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D 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. 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