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APPLICATION FOR SANITATION PERMIT Permit Na. _.l-? ............ (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. S49. ,,� JOB ADDRESS AND LOCATION..-------/_j__ ------- =-------k--`-� -�-- --'4 ' Owner's Name----------- .�----•--------------- -------•- ------------------------------------------ Phone------------------------------- Address--------_1. 6----� r`?t 7----------4�e-r------------�Try ' Contractor's Name_._W-J e4nffl l_ P 1e --------------------------------------------•------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ OtherIf ❑ Number of living units: __C----- Number of bedrooms _3__ Number of baths ___t___ Lot size __ p --x--- - -©------------------•----------- Water Supply: Public system Community system F1Private ❑ Depth to Water Table JP ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑-•,Sandy Loam ❑ Clay Loam ❑ Clay ❑_ Adobe® Hardpan ❑ Previous Application-Made- Yes ❑ No New Construction: Yes []�N0 ❑' FHA/VA: Yes ❑ No — TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep+ic tank or cesspool permitted if public sewerjs available wit hin.200 feet.) _ Septic Tank: Distance from nearest well__UP-4C---'Distance from foundation---#eI---------Material .______________________________________________ ❑ No. of compartments Size --=— ------ •,---Liquid depth--------------------------Capacity...--------•----------- Disposal Field: Distance from nearest weii__Pa Distance from foundalfion._=. �.____--__Dis#ante to nearest lot line____ ..______. 211� Number of lines-------------2r-----------------_Length of each line-----4 ------------------ of trench--------2---.--------------------- .� Type of filter material__jZ10<-P&----------Depth of filter material,.-,- - -------Total length---------- ---------------------- Seepage Pit: Distance to nearest well___/11D�_�•._____Distance from foundation____-L-0--:..___.Distance to nearest lot line...._-______. ©~/ Number,of pits--------I------------Lining material---1'26_e-I<------ Size:'Dia meter__6__'x_5..........Depth------6--- ------ ' Cesspool: Distance from nearest well_____________.__Distance from foundation--------------------Lining material---_________-________---______.____. Size: Diameter--------------------------------------Depth-------------------------------------------------� ---Liquid Capacity---------------------------- gals. e.. Privy; Distance.from nearest well---------------- ------Distance from nearest building---------------------------------------- - _ - ❑ Distance to nearest lot line---------------- -------------------------------------------------------------- K Remodeling and/or repairing (describe}---------------------------=-----------, --=-----------------•----------------•- ----------------------------•------- -------•--------------------•--- ------------ • 1 4 ----------I---------- -------------------- ---- -_� ==. '_--- --- ------------ =_ w I hereby certify that 1 have prepared this application and that the work will 6a;done in~accordance;with-San Joaquin County ordinances, State laws, and rules and,regulations,of-the San Joaquin Local'Health-District. A� ----------------------- ------------ -_� .--:-.1i Owner,and/or Contractor) j '[ ` (Signed)_ %_ --(Title)- - By:---------------------------------------------------------------------------- ---------------- `` (Plot plan, showing size of lot, location of system in relation +ii yell ;buildings, etc., can be placed on reverse `sid� ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ r- ------------------------------------------ ---------------------------------------- DATE--- -------------------- REVIEWEDBY---------------------------------- -- DATE---•-------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------- ------------- --------- DATE------------------------------------------------------------- Alterations and/or recommendations:.-. - - w LL� r e ¢------------------------------------------------- ----------- ~ r�-t�! 4 -- - -- ----- = { --�- '"�-A1 ---------------------- - ------ i�_. -- FINALf Slf� PECTION BY--------- - ------- -------------------------------------------- Date------------------------------------ ----------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Steef 300 West Oak Streof 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Ca.