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IrAPPLICATION FOR SANITATION PEKMIT 1 Permit No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued 1" Application is hereby made the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. l JOB ADDRESS AND LOCATI N..__ _ � I Owner's Name----------- --- Phone-__-------------------------------- - . � - - � 1� Address-----------------------------------------•-------- ------------- •-----.._---------------------------------------------------•--------------------------------------------------------......---------- n �J4 --------------------------- ------------------------- Phone----------------------------------- Contractor's Name------._.. ��..- �-_• � ------------------------- ------------- Installation will serve: Residence Apartment House ❑l Commercial ❑ iter Court ❑ Motel Other 't❑ 4 k Number of living units: _ Number of bedrooms Number of baths -o�"- Lot size - �=/ --------------------------- ` Water Supply: Public system ❑ Community system ❑ Private ®l-tepth to Water Table -Avft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe hardpan Previous Application Made: Yes ❑ 'No [ New Construction: Yes P"'No ❑ FHA/VA; Yes ❑ No B— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i r l ' Septic Tank: Distance from nearest welL_��_ _____Distance from foundation__��___-___-_Material....� - __________________ Y �f ❑� No. of compartments4~=_----_,�_-'-----Size_-"FZO_'n----------------...Liquid depth---_-6-----------------Capacity_,4tw`_--�' t� Disposal Field: Distance from nearest well i�_____..-Distance from foundation. -----;.----Distance to nearest lot line___ ]� Number of lines__l ________-----------------Length of each line z-_/ f ..--Width of trench.-99*?________.____-....- -,r i Type of filter material Je 10-4 -Depth of filter material___«j!--------Total length----/�.2__Arlo______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______.___.__---- Q ❑ Number of pits----------------------Lining ma#erial--�------.---------...Size: Diameter-----------------------Depth-----.-.--------------------- -;e Cesspool: Distance from ns�rest well-----------------Distance from foundation-------------------.Lining material-------_________----_----_-_ l ❑ Size: Diameter---- ------------- -=--------Depth----------------------------- ---------------------Liquid Capacity........---...-----•--------gals. s i � z Privy; Distance to Weare rest well______________________________.__._--_----.----Distance from nearest building y Priv Distance from nearest 9---------------------- --• - ----------�. , st.lot Ione-------= - ----------------------------------------------------- ------------------------------------------------------ ------------- R - - ---- --'1 ' a. ------------ ---------------and/or repairing(describe)________________�'` __.____f_. � ._ _ __� r - •.. ----------------------------- -- f g y ��e� - i � -id +£C --=` �_ A ��c �r ? ---------------------------- ----------------------------------- --------1'-------------------------------------------- -------------------------------------------------------- --------------------------------------------------- j 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 and regulations of the San Joaquin Local Health District. f*4 -- ------------------------------------------------------------, i (Signed)---------- T - ( Wer nd or Contractor] By:------------------------------------------ ' e---- 1t�---------------------------------ITi+le}-----40:--� r--- --------= (Plot plan, showing size of lot, location of sy t m in relation to wells, buildings, etc., can be placed on reverse side]. - FOR DEPARTMENT USE ONLY APPLICATION AG�EPTED BY------- �� ` `------------------------------------------------------------- ----- PATE J '---------------------------------- ( � , REVIEWED BY-----Jt-�._1-------------------- ---------------- ---------------- ---------- DATE---------------------------- -- ----------------------------------- ------------------------------ BUILDING,PERMIT ISSUED-------------------------------------------------------------------------------- ----------------- DATE-----t - ------------------ ----------------------- l Alterations and/or recommendations:------AR_Q_PT T ------fH�-----/NDLCFiT1~.D-----5Y-------vk- -s L------------------------------------------- ------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------- ----------------------------------------------- -----------SE ._N_s�rA?t�t�i. Qty 1v�C MQ't Fr.� �� / -f -� R,® - ------------- -- _ ---------------------------------------- ------------------------------------------------ ------ ------------ ------------- ' ----------------- ------------------ -------------------------------------------------------------------•----------------------------------•------ ----------------------------------------------------------- ----• f , FINALINSPECTION BY---------------- ------------------------------------------------ Date----------------- ------=------------------------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT e 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' Stockton, California Lod-+, California Manteca, California Tracy, California ES-9-"-2M Revised 8-'59 F.P.Co.