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J /5 b/ ��LICATION FOR SANITATION PERMIT Permit No— ( (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. 544, s -------_-------------- JOB ADDRESS AND LOCATION-- • � -------------------------------------------------- AX Owner's Name------------------------------- -ee� 5-----G � Phone-•-------------•--------- cco / -- f�� -Address - f S } ----- •--. Contractor's Name--------------------------------------- ----------------------• -------------------- Phone----------------------------------- Installation will serve: Residence 0, Apartme t ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/-- Number of bedrooms -,9--Number of baths ___/--_ Lot size _____(2-9---,k'-_- ----------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe'!, Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes V No ❑ FHA/VA: Yes ❑ No-19� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seer is available within,200 feet.) Septic Tank: Distance from nearest well------ Distance from foundation----40- --__ Material-_�Q-_.___-__-__-_-_______---------- No. of compartments.-- -a2----------.--Size----i!�' , _.Liquid depth_-- ----S_�1-_----.-Capacity...1 Disposal Field: Distance from nearest well.--_ Q___-_.Distance from foundafi0n.__/.0_,___�.Distance to nearest lot line---,5..... Number of lines---------- ------- Length of each line---_-_-_------�0------Width of trench--------�„-- Type of filter material------� --Depth of-filter material-- --�--------Total length---------4f^ci_-l-3------------------ Seepage Pit: Distance to nearest well-_----_-_- -----Distance from foundation--------------------Distance to nearest lot line----------------- ~ ❑ Number of p'sts------------------ ---Lining material--------'-----.--------Size: Diameter.----------------------Depth----_---------------------r---- � Cesspool: Distance from nearest well__-40, --------Distance froVfoundation -------.Lining ❑ material-------------------------------- ----- Size: Diameter---------------------- Liquid Capacity 9als. Privy: Distance from nearest well ---____i----------------------------------------Distance from nearest building--------------------_---------.--..-_____. I ❑ Distance to nearest lot line------------------------------------------------------------------------•--•-----•-••------------------------------------------------------- Remodeling and/or repairing (describe: _=' ~----- --- ,-,. -------------------------- ------ --------------------------------------•--------------------------e-------------------------------------------------------------------------------------------------------------------- -- -------------------- -------------------------•------------------------ ---- ---------- I hereby certify that I have prepared +his application 14 n .that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he Sn�loaquin Local Health District. (Signed) ---- = '-'- y (Own and/or on#actor) By:---------------------------------------•---•--------------------------------'-----------------------------------------&__Title)_ -----------------_ ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME T USE ONLY c� ,^ APPLICATION ACCEPTED BY- !' _ DATE--- 1' �j '[�-C REVIEWEDBY------------------------ ------It---- -- ---------------------------------------------------------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------- ,��.s�------------- ------------------------------------ DATE------------------------------------------------------------- Alte ations and/or reco,mTe dations: ------ - - -- ---- ---- ------- ------- - - ------------"� „A -----•------------------------------ ---- - ---- -- --------•--------------- - ------ i ---- --------- -------- ------------------------- ---� -'--'-'f• Ls+'� -----.L:f� - .--'------�-.11.��k.� f..�+-,�4.?-. 1�,��--'� --- ----- ----L-`�-'e�✓ -- e�-.0 =r�-�-_. FINAL INSPECTION BY:--- 2 ---- ------------- Date----- r � 1-------- -- SAN JOAQUIN�LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street► 132 Sycamore Sfraaf 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised 0.'59 F.F.Co. .