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f S APPLICATION FOR SANITATION PERMIT Permit No.Date Issued ___ /.t� (Complete in Duplicate) 7 y 2 _ ` This Permit Expires 1 Year From Date Issued __1______.__ � 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 =vwith County Ordinance No. 549, 1 G p JOB ADDRESS AN�OCATIIN------- - - - - -------------------------- 1- --�-------------- --- - ----------------- --Owners Name -- -•- ------ ` ' - Phone vo ---------------------------------- Address---------------------- -------- ... -----•- _ ------------------------•- Contractor's Name- f3 �.._.- 4 ---------------�- --'-- --- --- p -------- Installation ------Installation will serve: Residence ❑ A ertment House ❑ Commercial ❑ T ailer Court ❑ Motel ❑ Other Number of living units: 7_ Number of bedrooms ._�_- Number of baths _%Z-_-_ Lot size _ r_______________________________________ Water Supply: Public system ❑ Community system ❑ Private U Depth to Water Table c`1~P_ ft. Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Z Clay Loam ❑ Clay ❑- Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No N FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s4w er is available within 200 feet.) f Septic Tank: Distance from nearest well____ ___Distance fr m foundation__ _____l_6___.__._.Material___ No. of compartments_._.__.._ ! ____________Sie_ _ LA5 Liquid depth----- --------Capacity__ _ L/ I p -� v r Disposal Field: Distancei from nearest well------ Distance from foundation.,-_ �______.__-Distance to nearest lot Ifne__ __ __________ Number of lines_' �9_____ _______ ___-..___ Length of each line--------�-.9-__----__._._.Width of trench_ __-_, 1 Type of filter material__________- Depth of filter material____�_�_.._______-__Total length-----c G�__I.-_______-__-______ 1 4- r Seepage Pit: Distance fo nearest well--- -( _-(------Distance from foundation__ ---------Distance s o nearest lot line--.--5 1 Number of pits___-:-----------Lining material---------_A4,+,12.-Size: Diameter.-.------ -Depth_._2rS____-_-_____. -- Cesspool: Distance from nearest well-----------------Distance from foundation:__,____----------- .Lining material______..---------------------------- ❑ Size: Diameter---k---------------------- ----------Depth_----------------------------- ----- ------Liquid Capacity- ------------------------•gals. Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------__-___._. ❑ Distance to nearest lot line--- --------------------------------------------------------------------------------•--------------------------------------------------------- Remodeling and/or repairing {describe)---------------- ---•- ---------------------------{-------------------------------------------------------------------•----------------•---. ----------------•---:--•----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ -- 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 . -1, --------. r. ----`--=`., ----=-------------------------------- --- - - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION --N ACCEPTED BY... - DATE-2-711Y_------------------------ DAT ,1Y-4 0------------------------------------- REVIEWEDBY------------------------- -----------------------------------------------------------------------------------------------•--- DATE------------------------------------------------------------ 6UILDINGPERMIT ISSUED------------------------ ---------------------------------------------------------------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations__________________________ ---------------------•--- ----------------•---------------------------------------------- --------------•---•------------------------------•-----------•------------------------------------------------•---------- --------------------------------- -------------------•----------------- - ------------- ---•-------------------------------------------------------------------------------------------------------------------------- i, I r� FINAL INSPECTION , Date___ e----•- -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.