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APPLICATION FOR SANITATION PERMIT Permit No. .-�_______________� (Complete in Duplicate) z Date Issued ___ This Permit Expires 1 Year From Date Issued r 03— 170 —0--T Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereiides bed. This application is made in compliance with Coun in ce No 549. It 51 3 E - Su " , r y'� � 4'. K / JOB ADDRESS AND LOC N.- - " ------. .. --- Owner's Name- _..2 •- --------------------------------------- Phone---------------- -- Address-----------� ;t►- --------------------------------------------------------------------------------------------------------------------..----�-•----.....----------------------------------•- Contractor's Name. I-.-------- 7u�✓� '` ---------- Phone------------------------- Installation will serve: Residence ["Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel D Other ElNumber of living units: J_____ Number of bedrooms ;'�.--- Number of baths J____ Lot size ___9G//_.;._5-- ___________________________ Water Supply: Public system ❑ Community system ❑ Private [� pth to Water Table ft. Character of soil to a depth of 3 feet: Sand Ej.,Gravel E] Sandy Loam ❑ Clay Loam E-1Clay E] Adobe Hardpan El previous Application Made: Yes E] No w Construction: Yes gr'-'No © FHA/VA: Yes ❑ Notf— 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__��__r__Distance from foundation----b�...-_.Material___-------------------------------------------------- No. of compartments-------.�-----_. X_99_._--Liquid depth-----�_�----------- Capacity..___5ize______.,.�_-__x- -_� ____Ca acit Disposal Field: Distance from nearest well__*0__f_____-Distance from foundation___f---___--.-.Distance to nearest lot line.-t4`7?' --,- EJ Number of lines______________ ______Length of each line------- ------------ of trench_.__r�S!_`___.___._____.___ (�. Type of filter material--- e __-----Depth of filter material___._ -----------Total length--------19,021---------------------- r -e Seepage Pit: Distance to nearest well----/Ct7-_________.Distance from foundation__,�P______-___. istance to nearest lot line_S�__-___.- QNumber of pits-------I-------------Lining material------ ---Size: Diameter. X,6________Dept ______________ Cesspool: Distance from nearest well-----------------Distance from foundation---.---------------.Lining material----------- ___.__________________.._ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity------------------------ .gals. Privy: Distance from nearest well---_----------_--------------------_----------___Distance from nearest building----_----------------------------.-------. ❑ Distance to nearest lot line----------------------------------------------------------------- ----------------------.-.--------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------•-------------------------------------------------------- -------------------------------------------------------------------------- ---- --------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------- I 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 an regulations of the San Joaquin Local Health District. (Signed) ---- ---------------------------------------------------------------------- Owner and/or Contractor) g }---------------- gY ------------ {Title} ------ - ------------ - (Plot plan, showing size of off, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..............'Z ------------------------------- DATE---------- ; 3 .- o REVIEWEDBY---------------------------------------- ------------ ------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------- ------ DATE--------------------------------------------- --------------- Alterations and/or recommendations:------ ---------- ------------ ------ -- --------------------------------------------------------------------•--------------------------------------- -------------------- ------------------------------------------------------------------------------ ------ ------------------------------------------------------------------------------------------------------------ -------------- - ---- -------- f-------------; �-- c�- �— - -- - ---------- -------------------------------------------------------------------------- --- - --------- -- -- - -------- ---------- �_��-_--- ------------ ----------------------------------------------------- ----- - ----------- ----------------------------------------- FINAL INSPECTION BY:� L - _ y - ----- -- Date-----------��--�C-------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast 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.Ca.