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Permi+ No. ..�I-��----�-5.r-. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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. �j r JOB ADDRESS AND LOC N ---7p Owner's Name •- -------------- Phone----------------------------------- OW Address----------•----------- -? ------------------------- Contractor's Name � - ---------------------------- Phone------------------------.---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Living units: I--- Number of bedrooms --/.- Number of baths __1__ Lot size ___ -------------------------------- Water ------------------------------Water Supply: Public system 01-16-0mmunity system ❑ Private ❑ Depth to Water Table .��ft• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E3 , Clay ❑ Adobe Ej--Hardpan ❑ Previous Application Made: Yes ❑ , No g?'New Construction: Yes ?�J—No ❑ FHA/VA: Yes Zjr- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1P--------.Mater'al-------L�-&-- Septic Tank: Distance from nearest well_________________Distance_from foundation___ � No. of compartments._.-.-.,7_ --Size-- -�_.X_ -Liquid dapfh =/ ---------Capacity..�L-e9--�--- Q ' ___Distance to nearest lot line__..��__.-_..___- i Disposal Field: Distance from nearest well._______._Distance from foundation �.� g FQ Number of lines---•-------------�------------- Length of each line----- --_-- - � -Width of trench-_-- -- --.--------------------- Type of filter meterial_�;1 I Depth of filter.material__/Zf____-__.Total length-------------- (Q �/}}77- Dista ce to nearest lot line--seS-_-____-_ Seepage Pit: Distance to nearest well____ '-______Distance from foun ation___.�-f_.____-___. ®� Number of pits....../------------Lining material__A0-61 A0-614-Size: Diameter---J� ---- Depth____ i tante from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- Cesspool: D s i ❑ Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------- ------------------------------ ----- ------ --------------------------------------- f --•------------------------------------ Remodeling and/or repairing (describe):--------- D --------------------------------------------------- --------- ---------------------------------------------------------------------------•---------•----- ' ---------------------------------------------------------------------------------------------------------------------------------- --------------- --- 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)------------------------------------------- --------- ------------------------------ ------------ (Q�7�or Contractor) ----------- By:--------------------------------------------------- -----Title (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----r--A -R,0Z------ ----------------------------------------------------------- DATE------ �� --------------------- REVIEWED BY---------------------- ------------- -------------------------------------- ------------------------------------------ --- DATE-------------------------------------------- ---------- --------------- ----------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ - ------ --------------------------------------------------------------- Alterations and/or recommendations:._.______________________________ _-------- _ DrVT4.... - �, C ,- i - _ -_ --------------------------- ------------------------------------- • --------------- , ' -- - `.5�-- --------------------------------- FINAL INSPECTIO ----- -------•-------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Streof 132 Sycamore Sfreet 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California n ES-92M Revised 6-'59 F.P.Co.