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APPLICATION FOR SANITATION PERMIT Permit No. — T (Complete in Duplicate) k Date Issued ..............�' - __6 'This permit Expires 1 Year From Date Issued ;2,�3Sw lfrb—i� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descry ed, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...-Y__ t. Sl_ -_:-_ ->- Y- ----_------ -- - ":` w �,O ------- ---------------- ---------------------------- Owner's Name-------w�-�L ------ - ----- ---._. Phone-- --------------------------------- 07 Address-------- ----- ��G7-< 'r�i - {---"----------* . .- ----- .--- ----------------------------------------------------------------------. ContractorsName----------- --•----•--•-•--•-------•----•------------------------------------ ------------------•------ --------------- Phone---------------------------------- Installation will serve: Residenciei Apartment House E] 'Commercial ❑ Trailer Court ❑ Motel [-] Other [3Number of living units: __1-__._ Number of bedrooms __"f/ Number of baths Lot size __. ----_---------------- Water Supply: Public system X Community s stem ❑ ,/Private ❑ Depth to Water Table,3s_ ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No b( New Construction: Yes No ❑ FHA/VA: Yes ❑ No I I, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew is available within 200 feet.) Septic Tank: Distance from nearest well__ _______.____ ante from found�at' -_____.Mat 'al___-_ __ yy ff � Capacity-F-6-0-111r.-. No. of compartments---,3-----------------Size.---3-l4�0__-�-I-~-�Gu depth-_- ��- Disposal Field: Distance from neargst well. ---Distance from foundation____ ,.------Distance to nearest bine___ _______ ,/� �. /1 Number of lines____ _______ _ '�__ _Length of each line_____ __ ____ Width of trench.._o __ ________________________ 1 t Type - Depth of filter material___. __rp_- __ __Total length_____` _______________ ____-------- Seepage e of filter material -_ _ - Seepage Pit: Distance to nearest well__ LeDistance from foundation__ Distance to nearest lot line_'___.-. Number of pits-----)-------------_440;ffffaterial _____.1�_-_ __ S- : Dia eter----------------------- ___ _ Cesspool: Distance from nearest well_______._____.`DistSncd'From a ion___ ____.._____.Lining material-.__-__ __. Size: Diameter--------------------------------------De Dept h_ ------------ --------_Liquid Capacity-.'❑ -- ---- ----:-Distance from nearest building-----Y--, -_- -------�T---gals. Priv Distance from nearest well_____________________�"':_ ❑ Distance to nearest lot line----------------------------------------------------------------r---------------------------------------------------11---- ------------------ Remode' g and/ r repa ring (describ }:_.,.U_ LtsL1_.rr _--__-- ---------- ------ ----- --- -- �'-- +'J` ' ' ' -'- - ----------- ----- - ---r------------ ---------------------------- ----------------------- ----------------------------------------- --------- ---------------------------------------------- -------------------------------------------------------------------------------------------------------•I--------------------------- 1 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 d regulations of the San Joaquin Local Health District. (Signed)----- ' ----------------------- ----- ------(Owner and/or Contractor) By-------------------------------------------------------------------------------------------------------------•-----------------------(Title)------------- ----- --------------- ---- -- ------------------- 4 (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ------------ DATE I REVIEWED BY------------------ --------- --------------------------------- ....... C- - ------ DATE �� '. ! --------- BUILDING PERMIT ISSUED-----•------------------------------------------- -` . DATE Alterationsand/or recommendations:--------------- ---------------- -----------------------------------• -----------------------•-••------------------------------------------------------------ ----------------------------------------------------------------•- -----•-----------------------------------------------------------------------------------------------------------------•-----•-------------------------- ------------•----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ---------------------_------------------------------ ",-_� - - a FINALINSPECTION 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 FT Co. -