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iq . 6 APPLICATION FOR SANITATION PERMIT Permit No. ._C'..,�..� (Complete in Duplicate) Date Issued This Permit Expires 1 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 describe Thislfapplication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N_. � ------ `� - _ 'G----_.' ----------- .._ Ow'er's Name-- --✓1l- - v---------------------------- Phone Address------------------------- �i Con'tractor's Name-------------- j f - ---------- ---------------•---------------------------- Phone-------------------_---------__- r Instillation will serve:- Residence 0" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I � Number of living units: ___l___ Number of bedrooms -1-, Number of baths.:' .'tLot size ______________________________ i Water Supply: Public system ❑ Community system Private ❑ Depth to Waterjable 0---147+. heracter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;Z, Clay Loam ❑ Clay ❑ Adobe ❑, Hardpan C]Previous Application Made: Yes El No New Construction: Yes ❑ FHA/VA: Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: n No septic tank or cesspool ermined if u�lic-sewer is available within 200 e�_i Matey I____ __!____________________ Septic Tank: Distance from nearest well-.�_ --------Distance from foundation.-,� No. of compar+monis---------�----------Size---I�- -- --` --Liquid depth------,--,�,--------Capacity__��__r�___�_ f Disposal Field: Distance from nearest well---- _Distance from foundation../D_�___'___--Distance to nearest lot line----D--___-____ ® Number of lines___________ Length of each Iine1��- i_ Q__.__Width of french_______.�_ ___________--___-- Type of filter materiaL__ � _ _ Depth-of filter material_-__. �' -6--- ---.Total length---- Seepage Pit: Distance to nearest well------------_____y.---Distance from foundation------..............Distance to nearest lot line__-_____________- �[] Number of pits----------------------Lining♦material-----------------------Size: Diameter---------t---_---------Depth--------------------------------- t ' i Cesspool: Distance from nearest welf______________a___Distance from foundation--------------------Lining materia--------------_____.___________-__._ ❑ Size: Diameter---------------------------------� -Depth---------------------- ---------------_-----------Ligiid Capacity---- -----------------------gals. .. Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building------ - - ---------------_________ I❑ Distance to nearest lot line-------------}------------------------------------------------------- -------------------------------------------------------- ------------- , Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- --------------I� --------------------------------- • -- ------ I---------------------------------------1:----------------- ------------------- ------------------------------------=:---------------- ------------------ ------------------------------------------------------------------------------------------------------------------------------ ---------------------------•---------------------=--------------- I� I hereby certify t + I have prepared this application'and'that the work will be done in accordance with San Joaquin County ordinances, S e la s and rules and r gulations of the San Joaquin Local Health District. (SignI� ----------------------- ----------------------------------------------------------------------------------- Owner and/or Contractor) ed)------------------ --------- (plot pian, showing size of lot, location of system in relation to wells, buildings, etc.,,can be placed on reverse side). FOR ARTMtVT USE ONLY € APfPLICATION ACCEPTED BY----- j• / = ---- DATE----- ---------------- - eREVIEWED BY--------------------------------------------- ------------------------------------------------------------------------------- DATE----------------------------------`----------------------- BUILDINGPERMIT ISSUED---------------------------------------- -------------------------------------------------------------------------- DATE------------------------------------=---------------------- Alterationsand/or recommendations:-------------------------------------------------- ------------•--------------------------------.---------------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------IM ---------- ••----- - -- - ----- ----------------•------------------------• ---------------------------------------- -----------•--------•-------- ---------------•------ IM ---- --•------------•--•------------------•----------------------------•--------•- ----------------------------------------------------------------------------- ---------------------- •------------------------•-•------- ---- ----------------------------- 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 r5-9-2M Rcvised 8-'59 F.P.Co. �-