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S1 LY V A PLICATION FOR SANITATION PERMIT Permit No. -._00.76 1'V (Complete in Duplicate) r` Date Issued ---_ ls-7 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. , JOB ADDRESS A LOCATION_._ G.._ �� aC/h. -r"'� 5 -------------------•-------•-------�--I-------- Owner's Name---------- Q•' G-- - ----•-------------------- - --------------------- ----------------- ----- Phone.w`o---- - Address --------------------------------------•------------------------•---------•---------------•-- - Contractor's Name------. .-----------•--------------------------- -----------------------------------•-------------•------------------ Phone.----------------------------- - Installation will serve: Residence)!q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms -----'?—Number of baths -1------ Lot size __�_- _�_.- -----f--Q__-_------- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -------- ft.100 Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [] No New 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.) Septic Tank: Distance from nearest well_-b----_---Distance from foundation__.:4Q----------Mate rial_ s1- -r --_---__-----_- No. of compartments__--------------------Size.--�j{��_ -5-_---,---Liquid depth----4------------------Capacity..__9-0__0--------- Disposal Field: Distance from nearest weli__LL ,�i-__.._Distance from foundation____a.Q_______._-Distance to nearest lot line---- ------- Number of lines-------__)r---------- __----___ ength of each line-----L_4j---- -----____.Width of trench. _,,D__4`J_____--_---_- Type of filter material__ _- #kC.of filter material_------)_g_`'___.-Total length------J-__D_-0-_'------------------„ Seepage Pit: Distance to nearest well_____________________ Distance from foundation_____-__ i --------------------Distance to nearest lot line_-__-________.__- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------.---,--------------------- `t Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- AV, ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. IV Privy: Distance from nearest well----------------_---------- ----------------------Distance from nearest building--------------------------------- Distance to nearest lot line---------------------------- R odeling and/or repairing (describe)-__--- _ --- -- ------- - ----- � - - - Ems" ----------------------------- ---- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- 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) � - --------�----— ---------------------- --------------------------- ----------- ------------(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------- -----------------------(Title)-------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- ------- ------------------------------------------------------------ DATE------ -- --------------- ------------------------•---- REVIEWED BY ------------ ---------- -------- ------------------------------------------- ---------- DATE BUILDING PERMIT ISSUI=D-------• y - DATE Al rations and/or recommendations ------------------------- ----------- T= r ��[[ ------ ----- 'i_��.r-•,W.....z+e`e_•--- - -"--- :__-''f '�_^..----- '- ==•d`IFi/ -- -----•------ ----------- _ 1fr ,, ' -- ep ---•------�----•-- �-,,,-..,.= _----___•----- ------ ---------------- _.___.__-„___________________________________________F_____--_- _p_ _.--------------_-----------------------------------------------------------------------.__________--_- FINAL INSPECTION BY:. r'1-- - - ------------------------------ Date-------- - /� SAN JOAQUIN LOCAL HEALTH DISTRICT l 130 South American Street 00 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.Co.