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APPLICATION FOR SANITATION PERMIT Permit No. ............ (Complete in Duplicate) This Permit-Ex ires 1.Year From Date Issued Date Issued Application is hereby made to the San,Joaquin Local-Health District for'a permit to construct and install the work hereind escr ed V- � This application is made in compliance with County Ordinance No. 549. �[� „ ap JOB ADDRESS AND LOCATION ._---==�__- - '---- _ vc/:r'1 .�4- .. Owner's Name /91-- -low kf�! T% --------•---------------- ---- ---------------- Phone------------------- Address. + -:: U V 1----�Q- _ — fr/ s ` Contractor's Name--------------------------- _------------------- --------Y'----:---------•----------------------•---•----•---------- ---------.-- Phone------------------------------------ F Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _f-__- Number of bedrooms _, Number of baths 1----- Lot size ___a_ - _.. 9>,C /S0 Water Supply: Public system ❑ Community system K Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2f, Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:' Yes ❑' No ❑ New Construction: Yeses]_ No R FHA/VA: Yes;& No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permifted if public sewer is available within 200 feet.) .— j Septic Tank: Distance from nearest well__._-_ ---------Distance from foundation____-0--.-------Materr a--- ---------------------- __CdM�_j�� No. of compartments-----_---�-----•--.Size------S_4f-K r_Liquid depth--------f2__ ----------Capacity------ePQ-0---- Disposal Field: Distance from nearest well---- `r'"r------Distance from foundation.,-----/b-----Distance to nearest lot line------- ____ Number of lines--------------4n---------------Length of each line---------A90 ---_.Width of french----------HCl•"(----------- Type of filter material--- -----Depth of filter material-----------�all length___-____________�_�4_______.---- CA Pit: Distance to nearest well----------------------Distance from foundation__________.-_-.-___.Distance to nearest lot line__--_---.___-_.__ 5G ❑ 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 nearest well-----------------------------------.-------------Distance from nearest building-- .______.__---_------_____---_---__--.. ❑ Distance to nearest lot line------------------------ `---------------------------------------=------------ 1 . Remodeling and/or repairing (describe):__..-__--______ -- ---------------------------------------- . ---------- -------------------=----------------------------------------------------- 1 ----------------•------------------------------------•-------------------------•----•---- --------------------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------•------------------------------=---------------...----- -------------•-----------------------------------------•--------------------------------- --------------------------------------------------------------------------------------------------------------------------.-------•--------------------.---•-----------------------•--------------------------------------- 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 legulations of the San Joaquin Local Health District. (Signed-----Fd/ ---------------------------- ---------- - _ .e=t __ k------------•---'----------- - -- (Owner and/or Contractor) I By:--!----------- - - - ------------------------------- ---- -----------------------------------------(Title) - -(Plot plan, showing size of lot, location of system in.relation-to:wells,'buildings, etc., can .be:placed on reverse side).- r I i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- --- s - - DATE-----=- ------------` - fr REVIEWEDBY.--------------------------------- —'--- - `------•--------------------. DATE----- ------------------ BUILDING PERMIT ISSUED------------- ---- ----------- ------- ----------------------------------= DATE - �,,. .. t Alterations and/or recommendations:-_ _ -__-__ ""`_: -------------------- ••----------- ----------- --------- ------- ------ ----- -------•-------------------------------------------------------------------------- -----------------------------------------------------------------------,---------------------- 1 , --- -- --------------------- ---- ' J FINAL INSPECTION l BY---------- --------- - -- ----- - --- `J=, --- - ------------------- Date / 1� 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 I ES-9-2AA Revised 8-'59 F.P.Co.