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• �I APPLICATION FOR SANITATION PERMIT Permit No. _..1.. :?.7- (Complete in Duplicate) ' 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_com liance,.wit County. rdinance No.:549. JOB ADDRESS AND LOC N.._ a _ _��--_-_ --_ __ / � + Phone : Owner's Name-5tv --- .. Phone---------------•-------.------ ... Address---1CJ_ i I Contractor's Name.---- _ ._ ----- • - ---- -- -- - --------------------------- Phone_..-----...-•----------=----•----.. Installation will serve: Residence Apar men fOuse 'Commercial"`❑ rail r Court ❑ Motel ❑ Other ❑ Number of living units: _ - Number of bedrooms _ _ Number of baths .__ Lot size __- Water Supply: Public ysystem ❑ Community system ❑ Private f, Depth to Water Table _., 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 ❑ No -FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic ta'nk'or cesspool permitted if public sewer is available within 200 feet.) Septic an!k:b � distance from nearest well_ -Q. Distance from foundation___ /-- MarL_ -: ------ 41 , No. of com artments. ._. Size_ --Liquid de -----th__ Dis 0501 Field.: ' Distance from nest well- _ -----Distgance from foundation__-_. --.r_._ .Distance to nearest lot I --_ Number of lines Length of each ......... ____��ta€hleng#h�C (�____ w --- - --- ----- Type of filter material_„�T._ _ _ __Depth of filter material__._. -_ ._._ eepage pit: r Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line_.__:1_________- Cess ool: { rf 'Dsfance from nearest well_-Linin m{Distanlce from foundatonDiameter----Linin mat Depth al-th____---------------- ❑ p 9 p Size: Diameter--------------------------------------De Depth--_---,--------------------------=- =--------------.Li Liquid Ca acit I" gals, ❑ q p Y----------------------- 9 Privy: Distance from nearest well-- '----------------------------------------------Distance from nearest building---------------- _____________:__,-.______. ❑ Distance to nearest lot line--------- �a ---------------------,-------- ---------,------------------------t-----•--------------------------- �_ I" Remodeling and/or repairing (describe) "= =-� -!------------ ------------- -------------- - �"" :x 1 � � r ---------- -------------------------------------------- ----------------- -- ----------•----------- --------------------------------------------------- ----------------------------------------------- I ------------------- ------------------------ ' I hereby certify that 1 have prepared this a plication an that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed) -- ----------------------------------:----(Owner and/or Contractor) Y:--- f_•�C _L�,- c_'�''4,:=e"--•--... (Title)------------------- ------ - ---=------------ (Plot plan,, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY II - - DATE '` y APPLICATION ACCEPTED BY----------------------------- ----- ----------------------------------------------------------. DATE---------------- r- 41 REVIEWED BY --- - BUILDING PERMIT ISSUED----------------------------------------------------------'-–--------------- - --- DATE:----- - ''.� Alterations and/or recommendations:--------------------------------- — -- ------------� ------ .... _ --- -------------------'-------------- ------------------------------------ ---------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------- ..................................................... __..__ ------------------------------------- �1 � IFINAL INSPECTION BY: � --- Date.------. -------- ---- - -------- SAN F JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street) Stockton, California Lodi, California Manteca, California Tracy, California ' ES-9-2M Revised 8.'59 F.P.Co.