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y1y.�l� APPLICATION FOR,SANITATION PERMIT Permit No. �- /� ' I (Complete in Duplicate) Date Issued01 - - I�_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfal1,fhe work herein described. This application is made in compliance with County Ordinance No. 549. 1 q 3 3 Z JOB P+DDRE55 AND LOCATION__ � h _._ --_____ eS.... �liuCln - - - - ------- ---------- ----- Owner's Name---- ------ - -------------'...... Phone----------------------------------- Address_-. Z At......5 -------------e 1�-__-yh----- 1.4L-- --------------------------------------------------------------------- Contractor's Name-----------------Q 'QL/q~-------- ---------- - --------------- Phone-------•-------------- k - ----------------------------- - ----------------------- -- ------------ Installation will serve: Residence'` Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: _-t---- Number of bedrooms .7—_ Nu-tuber of baths _______ Lot size ------------------------------------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table ']_ ft. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam;, Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nog New Consfruction: Yes r' No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS'- (No septic tank or'cesspool:permitted if public sewer is available within 200 fee ) Septic Tank: Distance from nearest well__`� _________Distance from fo daJon_jd-__--_'__--.Material____ _.-______________ No. of compartments-------Z- -----------_Size-- - -` - _S_Liquid depth------y-------------- Capacity----. --------------! Di"sposal Field: ' "`Distance from nearest welt_.. fir -Distance from foundation__J-0------------ to nearest lot line____._-____I 1h Number of lines~_ ? -2 `,----- .�-----Length of each line-----GAF_______fi____-_--.Width of trench_---25(x'-'------- ---------- - Type of filter material____=4t..k--------Depth of filter material------?------------Total length_._r__/ ________________.._____ Seepage Pit: Distance to nearest well-----------------_----Distance from foundation--------------------Distance to.nearest lot line--__-__.______.__ ❑ Number of pits------------------------Lining material----------------------.Size: Diameter------------------------Depth--------------------------------- 3 Cesspool: Distance from nearest well-----------------Distance from foundation--------------.____.Lining material------------------------------------- El Size: Diamefer------ -------------------------------Depth--------------------- ---i------- -----------------Liquid Capacity------------------------- --gals. Privy: Distance from nearest well-----------------------------------____-------__Disfance from nearest building------------------------------------------- ❑ Distance to nearest lot line- -----"------------------ ----------------- Remodeling and/or repairing (describe):---------------------_------------------------- ---------------------------------------------- E ----------•-•-----•-------------------------:--------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------ ` 4 ____ ____________________----------------------------------------_----------------------_----------------------------------------------------------------------------------------------------------------------_---_______ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S Ta , and rules and regal tions of the San Joaquin Local Health District. (Signe - ------ ---------- ---------------------------------------------------------- --------(Owner and/or Contractor)----- - ----------------- k By:--•---------------------------------------------------------------------------------------------------------------------------------(Title)---------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f - - - `'_ ----------------------------------- DATE----- � REVIEWEDBY---------------------------------------1------------------------------------------------ ----------------------------- DATE BUILDING PERMIT ISSUED---------------- ------------------------------------------------------------------------ -------- DATE. Alterations and/or recommen ations--------------------------------•-1------------------------ ----------------------------------...----•------•-------------------•----•--------------------------- ---------------------------------------------------------------- ---------- ---------------------- --------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------- -----------------------------------------•----------------------------------------------------------- ------------------------------------------------------------•------------ J FINAL INSPECTIONBY:--- -j------ --------- ---- - --------------- Date...... --_� .- - - 7 SAN JO QUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 834 North "C" Street Stockton, California , Lodi, California Manteca, California Tracy, California ES----4---2M Revised 1-57 F.P.Co.