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�1 MO 'S CiAPPLICATION FOR SANITATION PERMIT Perini /e� 3 (Complete in Duplicate) �// This Permit Ex ires 1 Year From Date Issued Date Issued _`3/?`�I,6e"" Application is hereby made to the San Joaquin Local Health District for a permit to construct and install This application is made in compliance with County Ordinance N . 549. the work herein described. JOB ADDRESS AND LOCAfTIO --l _ /�- _-G -------.__ _ -- ----------•------------• ------------ Owner's Name-------------------- ----- -P - Phone"Address t; f ----------------------- - ---- - --------------------------- --------------- -----•-------••-------------_ -•-------- ----- Contractor's Name --------------- �;64 = Phone _`_ a� -- - . .T-" Installation will serve: Residence 5d Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other' ❑ Number of living units: ----V Number of bedrooms __1----- Number of baths ---I---- Lot size Water Supply: Public'system [E�Commun•ity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LN Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes �4 No [] FHA/VA: Yes [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: �\ Distance from nearest well-----------------Distance from foundation-_------_---_--" Material y No. of compartments Size Liquid depth--------------------------Capacity-•--------------------- Disposal Field: Distance from nearest well--/-W,:.(___".Distance from foundation...29 - -r-""-""--Distance to nearest lot fine-- M— Number of fines-=-------------/-----------------Length of each line--------------------------- ----- of trench-------" _ --------------------- ------ Type of filter maferialc?"Cr, ' Depth of`filter material--__-fz _ ___--.__Total length____-"-_--" __`__ Seepage Pit: Distance to nearest well ------Distance from foundation___ r f O _��____-.":Distance to nearest lot line.- Number of Number of pits---1----/------------Lining material---_f 7?!f Size: Diameter_'- _�'_ ------bepth------- "-'------------------ Cesspool: Distance from nearest well-----=-----------Distance from foundation_-------------------Lining material--_--._---_-__---__-----_--------"._ ❑ Size: Diameter. --i---- ---Depth----------------------- --- :-Liquid Capacity I r� -------- 9 ----------------------------gals. Privy: Distance from nearest well----------------------------------------------- -- Distance from nearest building ❑ Distance to nearest lot line-' ----------------------------------- and/or repairing (descri e):__. .._------------------------------- ------------------------------------------ ---------- ----------------------------- ---------------------------------- -------------- ------------------------------------ ------------------------•------- -•- - •------- -- - --------- - --------- hereb certify that I have - - - ------ ----------"---•------------------------------ Y y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- ------- ------- --- --- = (Owner end/or Contractor) ----------------------------------------------- By:-------------------- -------. r , P- �P -------------------------------------------------------------(Title)-------------- ------------------------- - ------ plan, showing size of lot, cation of system in'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------- APPLICATION ACCEPTED BY" _,.--e__,-_ --------- DATE_ - --�'-C► 0 REVIEWED BY ------------------ ------ ------------------------------------ DATE-------------------------- BUILDING PERMIT ISSUJ D -' Alterations and/or reco mendations: ------------------------------------------------- DATE------------------------ ------------------------------------ } a ---------------------------------------------------------- •--------------------------------------------- --- --- ------ ----------- --------------------------------------------------------- -r-- - --------------------------- ----------------------------------- - ------------------------------------ FINAL INSPECTION BY:"-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 306 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California - _ Tracy, California ES-9-2M Revised 8-'59 r,P.Co.