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? APPLICATION FOR SANITATION PERMIT �7 Permit No.....��..1 (Complete in Duplicate) fI� laG Date issued This Permit Expires 1 Year From Date Issued .- �1--------------- 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: ----1.5-3..6-/ k ® ._----------------------•------------------------------- Phone ------------ -------------------------------------------- � •Y!t--------------------------- Ph one ------------------------------------ Owner's Name --717A6 -------------------------........ - • - -- - - - -----�------•-------------- Address..Q - !7!a ---------;---------••-----------------------•------ --------•----------- ------ Phone.�A,� Contractor's Name-p.�x--- -- -- ---------•----- �!�� --------- ------- ---- ----------------- - Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms __I,- Number of baths -_I---- Lot size --- t5 -PX -1-4 - -------------------•-------------- Water Supply: Public system U��ommunity system ❑ Private ❑ Depth to Water Table 30-7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑- Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [E-- New Construction: Yes ❑ No [3—FHA/VA: Yes ❑ No El -- 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 from foundation -------------------- Material --------------------------------------------------- - ❑ No. of compartments -------------------------- Size --•------------------------ ---Liquid depth---------- --------------- Capacity--•-------------� Disposal Field: Distance from nearest Distance from foundation.. -J6 ---------.Distance to nearest lot line --4�------_. ----_ Length of each line ------ Number of lines--------------- 30 Width of trench------- -- --y------------------- Type of filter material.---�1- ---Depth of filter material/ ':% `__-------- Total length --------- 3=0_ Seepage Pit: Distance to nearest well ---------------Distance from foundation --JA -- to nearest lot line-_ --- ---------__._ Number of pits------- ------- -----Lining material -----e-K1 Diameter-----' X-.�-- ----Depth_..--,------ --- -- -------------- 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----------------------T----------------------------------------•------ •---------------------------------------------------------- ----- 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 r a regulations of t an�Jaquiin Local Health District. ------------ (Signed){Owner and/or Contractor] --------------------------------------- • Tale (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 APPLICATION ACCEPTED BY DATE------------ --- REVIEWEDBY --------------------------------------- ----------------------------------•--- DATE--- I l -------------------------- -- BUILDINGPERMIT ISSUED ------------------------ - ------------------------------- ••--------------------------------- DATE Alterations and/or recommendations:------------------------------------------------- -----------------------------------------------------...----...----------------------------------------------- -------------------------------------------------------- ��%- --- �`} AJ----- =/ r��_----------------------------------- ------------------- ------------------------------ ___ ---------------------------------------- ---------------------------------------------------------•---------------------------------•--------------- ---------------------------------------------------- ------------ ------------------------------------ ----------------------------------------------------------------------- -------------------------------------------------------------- G� FINAL INSPECTION BY:--eCf 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 Reiced 8-'59 FT Co.