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ga APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) i_ d This Permit Expires 1 Year From Date Issued 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 Coun Ordinance No. 549. JOB ADDRESS ANDL CATION _ SP-(v_G ----- � � , -� - ; �► wfi Owner's Name------------ +� Phone Address------------------- --- - ---------------- ---------------------------- ---------------...--------------------...-------------------------- --••-----------•----------------------------- . Contractor's Name ,pa , `' �f�----------------------------------------------- Phone Installation will serve: Residence g?`A�partment House ❑ Commercial ❑ Trailer Court,❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms _, .- Number of baths _j;P--_ Lot size __ r✓°__________________________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes o ❑ FHA/VA: Yes A�- 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__.___&Disfan�c.•ee from fooundation_..ItD-__.-_._.Material___6-4..�rio-f__________________ No. of compartments-___,�____-----------Size_%J' _A_4Z ?�_q#Liquid depth____'X�______--------Capacity.,42,e-49--- 10 Disposal Field: Distance from nearest weII4-0-_: `--Distance from foundation ��--.-Distance to nearest lot line__1Q__._____ Number of lines-----------l_.__ Length of each line_._._�(1p!______`__.Width of trench----oz_�_si --------------- Yp - p / -- /" Total length------1P- ------------------------- Seepage ---------------------- T e of filter material __ /` �/ De th of filter material_____ _ � See a e Pit: Distance to nearest well__ -. p 9 �/4V ----Distance frgm foundation__,/,XQ_.___.Distance to nearest lot line---,ff�._____ Number of pits....... _ _ _--_._._____Lining material___ P-e—k.Size: Diameter.__ ��____-Depth----s�.�_.�____________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------._______- .______________- ❑ Size: Diameter--------------------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. �. Privy: Distance from nearest well-_.-----------------------------------------____-Distance from nearest building---------------- ---___.____________._._. ❑ Distance to nearest lot line---------------------------------------------------------------•-------I------ ------------------------------------------------------------- 0, Remodelingand/or re a}r;n (describe):an / p g I ) r/ flW_ r ---------------------------•-------------------------------- ----------- ---------------------------------------4------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- --------------------------------------------------------------•---------------- ---------------------------------------------------------------------- ,--------------------------------------------------------------- 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, anA rules and regulations of the San Joaquin Local Health District. (Signed)----------------- ` ---------------(A�Contractorl 5�a --Y- ------ - -- ---------- ------ gY- ----------------------- ----------------------- (Title) � -------- .. --- (Plot plan, showing size of lot, location of syste n relation to wells, buildings, etc., can be placed on reverse side). FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY------ - ----------------------------------- DATE------ REVIEWEDBY-------------------------------------- ----------- ------------ --------------- ------------------------------------------ DATE--------------------•- BUILDING PERMIT ISSUED---------------- ---- --------------------------•----------- ------ DATE Alterations and/or recommendations:---------- --- ------- --------------------------------------------------------------------- .------------------------------- -------•------------------------- ----------- ------------------------ ------------------------------------------------------------------ ---------------------•----------------•------------------------------------------ ----------- ----- --/---------- ------ 'G -. - ---------------------------------------------------------- __ -------- -- ---------- -- ------------------ - ---- -- FINAL INSPECTION BY:. ------ --------- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+ra©+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 8-'59 F.P.Co. �n I