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Jvg APPLICATION FOR SANITATION PERMIT fermi+ No. ..r..-t.+. °I___ r " (Complete in Duplicate) � rr$ r u { p Date Issued ________[___..i___:_ 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 withCounty Ordina ce No. 544. JOB ADDRESS AND LOCA)ION ;V4, . y� Owner's Name /J/ ------- Address___ " Phone ` y ------------- --- ----- Contractor's Name---------- - fi -- t Phone-------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ pMotel ❑ Other E]Number of living units: ---/__ Number of bedrooms _J-__ Number of baths 4,/___ Lot size ____Gte� _---___________________________ Water Supply: Public system VoEommunity system ❑ Private le ❑ Depth to Wafter Table ft. 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.g�-_jHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f° (No septic tank or cesspool permitted if public sewer is available within?'200 feet.). Sept;c rT�a-n�: Distance from nearest well_________________Distance from foundation------------r_'___.Material-______________-_.----------------------------- . t*V No. of compartments--------------------------Size---------------------------------Liquid depth---------------- ---------Capacity---------------� 111 /. Disposal Field: Distance from nearest well_________________ istance from foundation----- to nearest t ��e._+.e _____ Number of lines____--_-_- __ �-- $�lrLength of each line___`__v __ 47__.Width of trench___ _________________________ qd( Type of filter materia`l_4.Xp4e1K_Depth of filter material-__- ��__'_-_Total length_______p_ ___ _____________ Seepage Pit: Distance to nearest we I___-!=______Distance frq{n foundation_4 __ _.___p.r�it to nearest lot line__. _K� J T Number of pits./---/IW-Lining material___ _ G`' Sixe: Diameter_- �c�-- Dept h---p ---------------- ,yy -------------------------------------- F] Size: Distance from nearest well_________________Distance from foundation material______-____________-______- ❑ Size: Diameter--------------------------------------Depth---•----------------- ------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------- .--______- Distance to nearest ��t line----------- � "` "•` • ---- - --- - ------------- i . Remodeling and/or repairing (describe):----------- - f ` ---------- . ----------------------•---------------------------------------------•------•---------------•------------ --•---------------------- --- < - ------------------- -----------=--------------------------------------•------------------------------------------------------------------------------------------------------------ I hereby certify that l have prepared this application and that the work will be-done in accordance with San Joaquin County F. ordinances, State laws, and ru4andegulations of the San Joaquin Local Health District. Sined Ali- ------ --- ---- -R - ----- --'>---------------------=-------------- �on+roc+or){ g )---------------------------------- ------- i By:-------------------------------------------------------------- -- ------ ------' ------------------(Title) - - ----------''- ---------------------- (Plot plan, showing size of lot, location of sy in rela+ion to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -F .5-7r----------------------------------------------------------------- DATE----- ----------------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------•. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------- --------------- ------------------------------ Alterationsand/or recommendations:----------------------------- ------- ----------•---•-----------------•--------------------------------------------------------•----------------------------.. --------------------- ------------------------------------------------------------------------------------- -------•---------------- -----------------------------------------•------------------------------- --------------------------------- ------------------------------------ --------•------------•---•---------------------------------------•------------------------------------------- ---------------------------------- -------------------------------------. FINAL INSPECTION BY:.-. ` Date---- ------- - ----- - -- -------------- ---------------------------- SAN,JOAQUIN LOCAL HEALTH DISTRICT.: 130 South American Street 300 Wese&k Street 132 Sycamore Street ` 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Revised 6-'59 P.P.Co. " F� }