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APPLICATION FOR SANITATIO / .� a r� . ......................... N PERMIT Permrt No (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ---- L _ei 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 compliance with County Ordinance No. 549. ! JOB ADDRESS AND LOCATION--- Owner's Name Phone ------- Address_________________ Z ---------- - ------------------------- Contractor's Name_ --P4----•--•- - �-------- ---------- -------------•-------- Phone..__...-•••-...- •------- :.r Installation will serve: Residence ® ' artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____L Number of bedrooms __Z_ Number of baths ----L Lot size 1`70---x66�-----_ ' Water Supply: Public system R Community system ❑ Private ❑ Depth to Water Table __y0 ft. Character of soil to a depth of 3 feet: nd ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V3-`Flardpan ❑ Previous Application Made: Yes No ❑ New Construction: YesNo ❑ 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_-4xs-y4____Distance from foundation-_--(-C.!_1--. -. f No. of compartments_---------)------------ MatenaL------/---------- -------------- _____ Size.3 X±S _ -------,---Liquid depth----._-----_--- .Capacity-2-G4 � I -------- - _7 Disposal Field: Distance from nearest well_ ..._Distance from foundation--la•____._____-Distance to nearest lot line__- Number of lines----------)-------------- ---------Length of each line-----------------------------.Width of trench--- y_' ---------------_-- , Type of filter material__'__R!o_C.4--------Depth of filter material--- .yTotal length------ --G- -'_.____---------------- -� Seepages Pit: Distance to nearest well_-Ikn -(_._____-_-Distance from foundation__ - f_______-.Distance to nearest lot line_J~/___.._ Ly' Number of pits-------- ------- g _ Size: Diameter__��w1.-----------.Depth------- ------------------------ Cesspool: j _____Linin materia �-__ ___- ,� Cesspool: D-iistance from nearest well-----------------Distance from foundation--------------------Lining ❑ Size: Diameter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building--_______.___._----__--__-- ... ❑ Distance to nearest lot line--------- -----------------=-- ------------ - -------------------------•------------- 0 Remodeling and/or repairing (describe):--------------------------------- --------- -----------------------------•--------------------------------------•---------------------------- --- - - - --- - --------------- - -- - hereby certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------- -- -- - --- ---------- ------------(Owner and/or Contractor)-----------------------------------------By:--------------------_--- --- ----- ----------- Title -------------------------------- - ------------- (Plot plan, showing size of lot, location of system ifs relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ----- - -- DATE------_ -•--- - -------------------------- REVIEWED BY - ---------------------------- DATE j' ---------------- ------------- BUILDING PERMIT ISSUED DATE -Alterations and/or recommendations:-------------------------- ------------------ ----------------------- ----------------------------- -- -----•-•----------------------- ---------------- --- - ---------------`----- ------------------------------------- - -- ------ ------ - -- �- ---------- -- ----------------------------------------------------------------- FINAL INSPECTION ------- -------- -- ----- ------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore $treat 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Co.