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APPLICATION ��FOR SANITATION PERMIT (Complete in Duplicate) 0 �2 Date Issued __-. This Permit Expires 'I Year From 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, JOB ADDRESS AND LOCATION-..-- -�_.. b--- -j, _-_---_ ,,/ Owner's -_-- Name___�7_e�rlt__.---.J_L_Q-, - '--- L Address------ _ ---- °� - ---------------•------------•--------------- •------------- -------------------- �r Contractor's Name--------- --- £ a -+------------------•---------•--------------------------------------------------------- Phone----•------------------------------ _ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court �otel ❑ Other ❑ r Number of living units: __I.- Number of bedrooms .9--- Number of baths _- -- Lot size --------------------------------------------------------_._ Water Supply: Public system ❑ Community system ❑ Private F-tepth to Water Table i-t5-7—ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan y p ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ ❑ Previous Application Made: Yes ❑ No ❑ New. Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sgwer is available within 200 feet.) �, Septic Tank: Distance from nearest well----��-_-/Distanced fom fo/ ndati n_--_- � to ii l?__ _Q17---.-- --_- - --- No. of com artments- .:- -Size X-- ppsquid de�h- Capacity___ D . compartments-_ -,- -- . .!f 31 - lKL -- `_.---------- Disposal Field: Distance from nearest well--- -_-Distance from foundation------ Distance to nearest lot line-_---� Number of lines--__-__ g A70__1_--Width of trench---------�_", ------------- � w s�------------------- Len th of each line-_---.-_--.--_ --------- Type of filter material._- p ^` g C /' yp s d{� - - Depth of filter material-------1 -._--------Total length 10;-------------- Seepage _______---Seepags Pit: Distance to nearest well___ 1-.�Uistance from f ndation___--,rnL-�C3istan�re to nearest lot line----, ` Number of its-- '�______Linin materia_____ C--- P $ g --._ =-Size: Diameter__.��---------Depth...... --------------- Cesspool: -a -----_-----_Cesspool: Distance from nearest well-----------------Distance from foundation-- -------------.Lining I material-------------------------------------- ❑ Size: Diameter--------------------------------- \---Depth------------------------------ ---------------------Liquid Capacity_-------------------------gals. ~ Privy: Distance from nearest well-------------------------------------------------- from nearest building---------------------------- ..._----. ` ❑ Distance to nearest lot line---------------------------------------------------------- r Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- I .� ------------- ---------------------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, Stat laws, a rules and regulations of the San Joaquin Local Health District. (Signed)-- --;--------------------------------- -------------------------------------------------------------------- -__.[Owner and/or Contractor) BY-------- -----------------------------------------------------------------------------------------------------------------(Title)---------------------- ---------------- (Plot plan, sho m size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). EPART T E ONLY APPLICATION ACCEPTED BY-- :.- ----- --- ------ - ------- ---------------------------- DATE - ---------------- REVIEWEDBY------------------- -----------------= -- ---- ---------------------------------------------- ----------------------------- DATE------ ---------------- ------------ ----------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------- ;. Alterations and/or recommendations:---------------------------------- --------------------------- ` --------------- .f:. - ; ---------- ------------------------- ------------- ------- ---------------------------------------------------------- --------------------- ------------------------------------------- .• ------ ----------- ---------_--------- f c FINAL INSPECTION BY:.--- ------ -----------------------1' --- ; Date-- -f- --- -ZS ------------ SAN JOAQUIN LOCAL HEALTH DISTRI T i. Y 130 South American Street 300 West Oak S}roof 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.