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APPLICATION FOR SANITATION PERMIT Permit No. ._�-27`-z. (Complete in Duplicate) \ a Date Issued .................--_f� This Permit Expires 1 Year From Date Issued D�� 'J� Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work herein d cribed. This a P"cation is made in compliance with County Ordinance No. 549. I �+�� JOB A DRESS AND LOCATyION _ 12.tr - --- ---------------------- Owner's Name +1 _.. -------------------- --------------------- Phonel............--------------------- ev Address ---•-€ .------. T- '�� ......1_A7 Id, Contractor's Name I ----------- ---•--- ---• ------------ Phone.------------------------------ Installation will serve: Residence Ila Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ I Other ❑ Number of living units: _I----- Number of bedrooms `13____ Number of baths '1..___ Lot size --- ------------------------------------------ Water Supply: Public system ❑ Community system ❑ Private I)o Depth to Water Table, :__ ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X] Clay Loam [) Clay ❑ Ad abe❑ Hardpan ❑ y Previous Application Made: Yes ❑ No W 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.) ❑ P G P. � foundation n ----- ------------------------------ Septic F I e tic an Distance from nearest we _________________Distance from oundationMaterial-__--- -- lapac�ty.____..______________ , No. of compartments --- Size__ ___ Liquid de th_________________________C Disposal Field: Distance from nearest well------------------Distance from foundation.___.--_______-._.Distance to nearest lot line-------..---_.--- i"V ❑ Number of fines---.------------------------------Length of each line-----------------------------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material__________________._Total length_____-R__________:____.____-_-----_-_-___- '' Seepage Pit: Distance to nearest well----- from_four ation___ -Q�_______.Dislance to nealt�est lot line_/0'-_._-_.. .4- - MNumber of pits_____/---------------Lining materia* )YO(- Diameter._s3,3---------- p r Cesspool: Distance from nearest well-----------------Distance from foundation___---------------_Lining material-I1_.______..__.____________________. Ir Y-: � El Size: Diameter - Depth Liquid CapacitY1----------------------------gals. Privy: Distance from nearest well- ._ --__.._____Distance from nearest building__.__.l`------------------------------- ' ❑ Distance to nearest lot line--------------------------------------------------------------------•------------------------------------ ------------------ Remodeling and/or repairing (describe):_A4"_'E•1-1-- ----------------------- ----------------------------------• 1 ---------------------------------------------------------- -----� --------- -------------------------------------- .------------•-------------------------- ------------------.-------------------- -- -- 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) .. j By:------------------------------------------------------------------ -----------------------------------------------------------------(Title)------- -- ---- -I1' --- --- l (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s-` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,// I _______.__------------------------- DATE. - --- -- ----- -------- - ------------------------------- REVIEWEDBY----------------------------------------------------------------- -------------------------------------------------------- DATE----------------- BUILDING PERMIT ISSUED--------------------------------------------------------------—---------------------------- --------- DATE--------------------------M--------------------------------- Alterations and/or recommendations:-----------------------------------------------------------------------------------------------------------------------------I, I 11 IN -----•--------- --- ---------------------------------------------- ------------------------------------------------------------------------------•----------------------------------------------------------------------- Il ---------------------- ------------------------ ------------------------- ----•- --------------------------------••----------------------------------------------------------------------- ------------------------------ FINAL INSPECTION BY:.- ------------------ Date.../h / ---- ---------- II SAN JOAQUIN LOCAL HEALTH DISTRICT I 1k 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy . California FS-9-2AA Revised 8-'59 F.P.Co. II'