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` a APPLICATION FOR SANITATION PERMIT �Permit No:. .. 3. U ' (Complete in Duplicate) This Permit E. ices 1 Year From Date Issued Date Issued ------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install twork er i described. r This application is made iin�compliance with County Ordinance No. 549. Zn-0—!f 5—Lf JOB ADDRESS AND LOCATION___ Owner's Name - .0 ------ t, - � - - ------------------ _ h one ------------------- Address----------- ............. . - ---..... Contractor's Name____________________ ______ Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: #_/__.- Number of bedrooms 3 Number of baths _ -- Lot size 1aL_' '_-- 0.4;--I ------------------------- Water Supply: Public system :❑ Community system ❑ Private E] Depth to Water Table_ '_,�ft. Character of soil to a depth of 3 feet: Sand E]—'Gravel ❑ Sandy Loam K Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes $ ❑ No �Ne Construction: Yes [e"-No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted ifublic sewer is available within 200 feet.) p Septic Tank: Distance from nearest weIIJrO istance from foundation_-,&_. aterial-____ G- Q ® No. of compartments !N Size_ - y5r ._Liquid d`pth� -------------Capacity--/ Disposal Field: Distance from nearest well_514`_V!w..pistance from foundatio Zd7KA` Bistance to nearest lot line____'" ir4.�-.•r,� 1 Q a... �f-------- Number of'lines Length of each line_ _`s!f_ _ - -ZO-Width of +Tench_.__ _ ------------------ _ r 54 Type of Pilfer material----�i � --Depth of filter material_____/__!'_____Total length--- - -------------- h Seepage Pit: Distance to nearest well--_-------- --------Distance from foundation--------------------Distance to nearest lot line__.____-.______._ ❑ Number of�pits- r , - Lirin�g material---------------- Size: Diameter Depth Cesspool: Distance from nearest well------___----Distance from foundation-----_--------------Lining material--.__.--______________---_.__-_- [] Size: Diameter__________________ n -------- -----'---Depfih-------------------------------------- --------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well---------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line----------------------------------------------- Remodeling and/or repairing (describe)__________________ f---;---_ - ----------------•-------------------------- --•--------- '{-------- -------------------------------------- --------------•-----•----------------------------------------------------------:----------- - -in ---------------------- 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. (Signed)--- a •^ ------------ -------------------------------------------------------------- -(Owner and/or Contractor) BY� •-------------------•---------------------------------------------- Title of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). � i 8 FOR DEPARTMENT SSE ONLY APPLICATION ACCEPTED BY_._______.__ - - - - - ---- - -ATE---------- ----- -- ----�-�------==------- REVIEWED BY ----- --- - --- ------ --- DATE -----------•------------- BUILDING PERMIT ISSUED--------------•--- ------•--------------------------------- =--=--=--=--- ----------------------------- DATE--- ---•--------------------- - Alterations and/or recommendations:-----------------__----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----•--------- ------------------•--------.---------------------•----------------------------------------------- ------ --------------------- --------- ----------------------------------------------- -------------•-----------:----- --------------- � -FINAL INSPECTION = Date ------------------ S= f ----------------------------------------------- SAN - - --------------------------------------- AN JOAQUIN'LOCAL HEALTH DISTRICT J 130 Soufh American Sheaf 300 West Oak Streof 132Sycamore Street 814 North "C" Streef Sfockton, California Lodi, California Manteca, California Tracy,,California ES-9-2M Revised 8-'59 F.P.Co. - ,. s