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to APPLICATION FOR SANITATION PERMIT Permit No. 7.3 - 8 (Complete in Duplicate) /d / This Permit Expires 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 herein described. This application is made in compliance with County Ordinance No. 549. t G - JOB ADDRESS AND LOCATION,---9X/-f-.__ -___�_ __-•--- •--•------------_--- -------------------------------------------- ------- - -�„t�-- � �-�� J ---------••----------•------------------•---.. Owner's Name --------- `r' `— -------------------- ------ Phone------------ ' Address-----------_ � Contractors Name____ __ ______________ --------•-- --- - •--- - -------- --•-- •- - -- --•---------•--- Phone Installation will serve: Residence [`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms .Z._ Number of baths ---/... Lot size ��`�_:�/-�-_-____•-------_ -------------- Water Supply: Public system E31--Community system ❑ Private ❑ Depth to Water Table C - ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z31Rardpan ❑ Previous Application Made: Yes ❑ No U�lew Construction: Yes UL,—No ❑ FHA/VA: Yes ❑ No [L � 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 -fronf-i' u�' nclation___________._.____Material_____._____-__._____._ ------------------------- No. of compartments Size-_-_---------------- --Liquid depth------------------ -------Capacity------------------- Disposal Distance from nearest well--- _.DiifY to from foundation__—/----------- of trench.____•2-y_'-___.__ ' ------- Type of filter material-,_ _ Deptaf filter material:--/k_3_ e l -------Total length-------•-3--•----------------------- ---Q Seepage Pit: Distance to nearest wel€_ �-------Distance fr fou 'a#ion__ Gt_�____-__. __ Distance to nearest lot line_________________ y . i� Number of pits.-_�---------------Lining matenaL___. __ - ._ _ ._.S¢e: Diameter._._ a_____..._--Depth_.._--.' s3` _ Cesspool: Distance from n1.earest well---------------._Distance from foundation---_-----------------Lining material-----------------------___- ❑ Size: Diameter--------- -------------------- -------Depth-------------------------------------------- -- --Liquid Capacity- --------------- ----------gals. V Privy: Distance from nearest well _________________________�_-_________Qistance from nearest buildin g------------------------------------------ ❑ Qistance to nearest lot line -------------------------------- - --------------- Remodeling and/or repairing (describe)---------------------------------------------------------------------------•--------•---------- ---------•--------- -----------------------------------•------- ------------------------------------------------------------- ------------------------------------------------------------ -------•--••--------- --------------------------------------------- -------------------------------------------------- - i I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and le and reg lefions of the San Joaquin Local Health District. (Signed)--------•-- --------------------------------------------------------------------------------- ------.(Owner and/or Contractor) BY= -•------------------- - (Title)) ------------ ---------------- -............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY------ -- �U------------------------_---------- ---------------------------------------- - DATE------ REVIEWED -- -- - _ - --------------- ' BU€LDING PERMIT ISSUED ---- ------ ---------------------------------------------- ------ DATE------------•-------------------- -------------------------- -------------------------------------- ------------------ DATE Alterations and/or recommendations:__________-------- ------------------------------•--------------------•------------ - ---------------------------- .--------))---------------------------------------------•-----------------------------------------------------.------------------------------------------------------- - ----------------- ---------------- ---- ------------ -- -------------- --- ----------------- • ----••--.----- FINAL €NSPECTION BY----------- ---------------------- Date --'- - --------------------- 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 ES-9-2M Revised 8-'59 F.P.Co.