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} y APPLICATION FOR SANITATION PERMIT Permit No. _)f g�7 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ---- Application -_Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliancer�#y Ordinanc(-, 549. JOB ADDRESS AND LOCATION--------- ---- ------ =- --- ---r-----•-------------- Owner's Name------------------ etrs. - �r �-- Phone------------------------------------ Address ------ ------------------------------ --• ---------------` ,y Contractor's Name /,/�/ ------- -------••--------t----•-------- Phone�/J�l�_fij Installation will serve: Res"idence ❑ fApartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ P Number of living units: -------- Number of bedrooms -------- Number of-baths -------- Lot size ------------------------------------------------------------ Water Supply: Public system Community system p Private :❑- 'Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand {] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: Yes ❑ No Ej--New Construction: Yes E]--1qo ❑ FHA/VA: Yes ❑ No ❑ 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---S--i2----_Distance from foundation-_./D----_-_._.Material_.____ -�+/S. Q� No. of compartments------- ----------Size--------------------------------Liquid depth----.-------------------.__Capacity-,R-t-�-o------- Dis osal F Id: DistNumber of lines from earest welL__v __Distance from foundation--/45-..----.Distance to nearest lot line„-----_-- - . ---- _ {' Length of each line------��- -0-----ai-----.Width of trench.. -•�r� ---------------•- 0 � Type of filter material--- __ _lam-Depth of filter material--__{r- -----Total length--_._.-_ ___ e -,C _ _ Hca Seepage P' -: Distance to nearest well...--/- ---.--Distance fro fou dation_--fid_____--.-.Distant to nearest lot line_ Number of pits.---_-._/_---------_Lining material__-_W __Size: Diameter__._-- r Depth-. ---.-------- i ' 17-1 Cesspool: Distance from nearest well-----------------Distance from foundation--_--------_----.-.Lining material----.---__-_ _ _.- .--_--------.--,_-. ❑ : , Size: Diameter------------ --li------Depth------ -------'-----------------------------------.-Liquid Capacity----------------------------gal s. s) Privy: Distance from nearest well-___---------_-----------------------------------Distance from nearest building----------------------------------------- F1 ---__-------_---_ .❑ Distance to nearest lot line Remodeling"and/or repairing(de'sctib`e�: •------- ---- --------------•--•--•-------------•-----------•-------------------------------------•------------------ -----------------------•----------------------=--------------- ------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------- _._---_----_--_.-_-_-___--_-__--------..__-----_--__--__-_-----___--__---_---_-....___-__--_-_-_----_____-_.•-•_--_-______----__.-_-_-_-_-- ---_----____----_____-_-_._---_--_-_.--_...- ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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�,Id lations of the San Joaquin Local Health District. I 5i sed s( 9 )•--------------- ----- ---- (Owner and/or Contractor) ( e) Plot plan, showin- size of lot,'location lof system in relation to wells, buildings, etc., canbellaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------- --- - -------------- ------ ---------- -------------- DATE----------- ---- REVIEWEDBY-- ............ ---------......-4--------------- : - ------------------------------------------ DATE------- ------------------------------ BUILDING PERMIT ISSUED_------ ¢•-- {------ -------- ------------DATE_.- ------- Alterations .. Alterations and/or recorrimeridetions:.- ----- -----=------------------------------•-------------------------- ---;------------- - ------------------------------------------------- -p. -------------- ----------- ---- - _ g �o --.�-- ` --------------------------- ----- • -- --- --- --- �. -------------------------------------------- FINAL INSPECTION 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 r.P.Co.