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sZA� s APPLICATION FOR SANITATION PERMIT Permit No. ... ......'L:.. (Complete in� Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ----- ....a_d 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. N�o. 549. �(� � Q�J JOB ADDRESS AND LOCATION--- .. 5 "-�"^"" i � I ----- ------------------------------ ---------------------------------------------- ........ - Owner's Name--•----•--------•--a---� 1'�-------- -Q _Y1 �' p`5-------- ---------------------------------------------- Phone-----•---------------•-•--•--------- Address•-----------•-----------•-----•---•-•.......-- Contractor's Name.------------- QYLI------ .`Rc.-.----C�?_t�rv_t.�sz..--._...__..._.. Phone---�,�Q.. �.. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I--- Number of bedrooms -__ Number o baths -1------ Lot size __c ._?S/_ ______________________-_-. Water Supply: Public system E] Community system ❑ Private Number to Water Table 17 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [:] Sandy Lo;9No lay Loam C] Clay E] Adobe E] Hardpan F]Previous Application Made: Yes E] No, New Construction: Yes ❑ FHA/VA: Yes ❑ No n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic T Distance from nearest well---iO4_..___Distance from foundation-_-__�_ Y I C ----- 5--Y -Q--- -- No. of compartments________._Z--_ Size_____ � _.Liquid depth._.__ __./'2�--____Capacity..._��_._______ DisposalEtld: Distance from nearest e(I__,}tr0-.----Distance from foundation.. 9...�---------Distance to nearest lot line--4S .�...... [1 Number of lines---------- ___`_________________Length of each line-__ iT___--.Width of trench--_ -y. :_=_ '-_______-__- T' pe of filter material_'Y'Qr._1--------Depth of filter material---__----------------Total length.......... d.___---------............ Seepage Pit: Distance-to`nearest1-_,___Distance from foundation---1.0...........Distance to nearest lot line._5_�------. [ Number of pits__-_,_______________Lining`material__Yv_�-_ ___.Size: Diameter__._.3_�_1_�_-_Depth____�._S_�_-_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___---_--_-_-_-._-_---_-.---___-____-. ❑ Size: Diameter-----•--------------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _____-____--_.--------------------------------Distance from nearest building____.______-___..__-___-___---.-___. ❑ Distance to nearest lot line------------------- ---•---------- ---------------------•-•-•--------C----t-----------•-----------•-------------------------------------- - Remodeling and/or repairing (describer, ...............— ---- e' -.-T--- `� 1 � e ---------------------------•-------•-•----------•----•----•-----•--------------------------------------------------------•---•------•------------------------------------------------------•------------ ---------------- ------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------- 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 J aquin Local He istricf. !lo - ---------�o_o_T__ _ e_LtJ -12------.--- ��2 v/C-e--------- (Signed) --- - - - ---- (Owner and/or Contractor) By:............................. r Title (Plot plan, showing size t, loca�ystem in relation to wells, bulkKirg's, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ---------------- ----------------------------- DATE------ ----------------------------- REVIEWEDBY-------------------------------------------------- ------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-----------------------------------•----------------------------------------------------- --------- DATE---------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------- •.... - - ---- :: --•------------------------------------------------------------------------------------- ------------------ / --- ---- ------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. - -.- ------ ------------- Date.----- -------------------------------------------------- SAN ------------------ -----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 ES-9-2M Revised 8-'59 F.P.Co