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f APPLICATION FOR SANITATION PERMIT Permit No. .. ----- (complete �? Y - - (Complete in-Duplicate) Date Issued .-------------------- ma _.�!_�o---- a¢.v This Permit l:x ares 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct andri��ll theowo herein described. This application is made in compliance with County Ord inance No. 549, I JOB ADDRESS AND.LOCATION - -- ' Owner's Name------------ Phone---- ----•------ Address. ----------- Contractor's --------- _ ._ � AJ Contractor`s ------------------ ----------- ---------------------- ------------- Phone Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__- mber of bedrooms - 4— Number of baths -/__. Lot size �.-L-,�,--'3_ Water Supply: Public system Community system E] Private ElDepth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam E] Clay E3 AdElHardpan F]licati Previous,A . Yes'❑ 1 No New Construction, Yes No PP on Made:. FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _.(No septic farsk_or=cesspaol perm,it+ed,_if public s wer is available within-200 fee`) �� ff T ,�a,� t . . _ — Septic Tank: Distance from nearest well'--=�Yivl&tance from fourid n1 IOlateriaL 'i._ _C -C�} ------------------ No. of compartments- ,:!':� ,--_-_.__size____-- q P. apacity___-�� _C7 7%t�'v - line.-2- Number - - �.-__Li wd de th- Dista .to nea Disposal Field: Distance from nearest well-'_----Distance from foundation./4' , a, ;rest lot line.a-wit f 1 Number of ---- -___-- -Length of each line-------- Width of trench ,2_(------------------ _ Type of filter ma;eriaf__-5.z_ jepfh of filter material_---r"1.�___--------Total length-____t__.,.'�__Q.�_________________. �N- I Seepage Pit: . � Distance to nearest well------------}_--------Distance from foundation—-----------------Distance to nearest lot line_________________ ❑ i Number of pits---------------------Lining X material-----_---- ----------- Size: DiamJ er Depth----- --------------------------- Distance nCessPool: reswell-____=i____-.____Dst+�ce from foundation... ______________i ;Hung material_.__❑ SizeDiameter - __------------------eoF9d Capacity-.-------------- _ F -- : gals. Privy: Distance from nea = Priv y , rest well____-a___ ____________________________bistance from nearest buildin g------------------------------------------ ------------------❑ Distance to nearest lot line - � ---- ----- -- ----- ----- ------ Z. - Remodeling and/or repairing (describe)_______________________ w,�.. ` :qN ------------------••-- _ . ------------------------ ----------------------------------------------- ------------------------------------------------- ------------------------•-------------------------------- --- --------------------•----------------------------•-•---- --•------------------------------- -•---- 1 - hereby certify that f have,.prepared this application and that the work will be done in accordance with San Joaquin County rh ordinances, State laws, and r'ules�andyregulations of the San Joaquin Local Health District. Q, (Signed)_ �-- ------------------------[Owner and/or Contractor T= By:------------- ---•-----�-----••-- = T' r :--.- ----:--------------------------[(Title)-------------------- -------- (Plot plan, showing size of lot, l0catio# of system in relation to wells. buildings, etc., can be placed on reverse side). 4 F .R D TME %USE ONL ' APPLICATION ACCEPTED BY ATE :-.- REVIEWED $Y------------------------- ---------- ' � - --------------------------------•- ------ DATE---------------------------UILDING PERMIT ISSUED- ----- j--------- DATE. Alterations and/or recommendations:__.--__.__._._.-_. :' -----. ------- --------------------- -------------------------- --------------------- i ----------------------- ------------- ------------------------ - - -------- ---•-------•--- - -- -- 4 FINAL INSPECTION BY:.... -- I' Date-- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, Californie Tracy, California ES-9-2M Revised 8-'59 FY Co.