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APPLICATION FOR SANITATION PERMIT Permit No. ....1.. .�..�-�- (Complete in Duplicate) -✓__.f >, 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 described. This application is made in compliance with County Ordinance No. 549. /2-�r—Q90 r-O 2 1111111 1:69a:21; JOB ADDRESS AND LOCATION ------ --_ - / Phone------------------------------------ Owner s Name /;/?`_.= � /�Y � -• '� Address _ -ejA� Ai f . /1/• , -� l A � Contractors Name-- . - yAD1 � f ----- `J� ,3/ Phone. . Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Cou ❑ Motel ❑ Other ❑ «�� Number of living units: __�--- Number of bedrooms ---__- Number of baths,_: Lot size -----._l---_. /� -- Water Supply: Public syste Community system 11 'U Private ' Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand Kw Gravel F1Sandy Loam ElClay Loam ❑ Clay ElAdobe C] Hardpan E]Previous Application Made: Yes E] No F1 Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ff - j ----- Distance fro foundation- - Matenal_� ff-r�� septi :Tank: Distance from nearest well_.-- � - � --' --- - .• y til No. of compartments--------------- �---Size--- -----XLH-----Liquid depth---- --/_-C1-------Capacity---- ------ 77�� _r-_--Distance from foundation..-,�Q----._--Distance to nearest lot line---,:5'(--.- Disposal Field: Distance from nearest well.-� ,,f Number of lines-------- /------------------------Length of each line-------AQ10__---_------Width of trench---r ------------ - ` Type of filter material--- (/e-:-_--Depth of filter material---4k_____---. Total length_-_.-__�( -.--------•------ Seepage Pit: Distance„to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- w ❑ Number of pits----------------------Lining material----------------- -.---Size: Diameter-------------- --------Depth-----------------------------.--- Cesspool: D+stance from nearest well-----------------Distance from foundation__-----------------.Lining material -_--_------_---.------_---__---- ❑ - ----------Death--------------------------- ----Liquid Capacity----------------------------gals. Size: Diameter------------- ---------- -------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ i ❑ Distance to.nearest lot line ------------ --------- - - ------•-------------------------- ------------- - ------------------------------ Remodelin and/or repairing describe --------•------------------------------------------------------------ -------------------•---------------- ------------------------------------------------------- ---------------------------------------------------------- ------ ---- ------------------------•--------------------------------------------------------------------------------------------------------------- 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules rrd re ations of the San Joaquin Local Health District. (Signed)------ e---_ /{ " - `(Owner and/or Contractor) -------------- ------(Title)-- _.-.-�_�III,�� --- -- - ------ ---------- -- =-- - (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY !` G DATE-----------F- �- O--------------------------- i REVIEWED BY--------------------------- - DATE BUILDING PERMIT ISSUED-------------------- - ------------- -- --------------------------- - ----- ------ DATE DATE----------------- ----------- -- -- ------------------ -- t Alterations and/or recommendations--------------------------- - ----------- -------------------------------------- ------------------ --------------------- - -------------------------------------- ----------`� --- - ------ - -------------------- ---- ------------A ------------ ------------- - ---------------------------- ---------- ------------------------------------------------------------ C +J FINAL INSPECTION BY:.- Date --- K SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California k ES-92M Revised 8-'59 F.P.Co.