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APPLICATION FOR SANITATION PERMIT Permit No ..... (Complete in Duplicate) I� p Date issued This Permit Expires 1 Year From Date Issued ._.....-- Application is hereby made to the San Joaquin Local Healfh 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 AND LOCATION ---"__4_&F/.94 _:_ Owner's Name------ o V q_� i _f� :_ =' =. - P, ne..L.._ ---�-"l_; ---- ,y',�. �, / fJ d I Address k�'i� --- -44— '--II - - -------• --- o Phone •..--..-- _• - f , Contractor's Name ------- �-*r Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ w x - - f Number of living units: I_____ Number of bedrooms ._1- Number of- baths "-�:___ Lot size _s��_. r4-�--------••-------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table o__ ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No It New Construction: Yes or No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well____✓ ------_Distance from foundation__________________ Material ------------------------------------------------- ❑ No. of compartments -------------------------- Size ------------------------•--- ---Liquid depth---------- Capacity----------- i i Y. Disposal Field: Distance from nearest well .___--�_0.... Distance from foundation ---- &�_._._-Distance to nearest lot �ine_�l----------- j} Number of lines---.--------- /------------- Length of each line _______.�Q-----f�-------Width of trench..._112 -------------------------- !� Type of filter mate rial-_------ Depth of filter material ---- )s ----- ------- Total length ------ ----------------------------- Seepage Pit: Distance to nearest well ---------------------- from foundation --------------- to nearest lot line_______ ________- El Number of pits---------------------- Lining material -------------- ---------- Size: Diameter------------.- --- ---- Depth --------------------------------- 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 ---------------------------------- F1 Distance to nearest lot line ----------------------------------------------------------------------- ----------------------------------------------------------------------- ` Remodelingand/or repairing [describe)------------------------------------------------------------------------------------------------ ---------------------------------••----------•------------• 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. {Si ned'-<------------------ �or Contractor) 9 ) , (J By:-------- • r -r.- {Titlel -. _------ ------------- (Plot plan, showing size of lot, location of sys+em in elation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY ------.....-•--------- DATE... - - ---------------------------- APPLICATION ACCEPTED BY-- _ _ _-------- --------------------- � � REVIEWEDBY--------------------------------------------------------------------------------------------------------------------•- DATE ------------------------------------ ----------------------- BUILDINGPERMIT ISSUED ------•---------- '--------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:-------------- ------------- ------------ --------•-----------------------------------------------•------------------------------------------------------- -----------------------------------•-------------------------------•------------------------------------------•------------------------------ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------- ---------------------------------------------------- w { FINAL INSPECTION BY:-,--- 'r � � = Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street s 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California ES -9-2M Revised a-'59 F.P.Co.�•' ' 814 North "C" Street Tracy, California