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t o� APPLICATION FOR SANITATION PERMIT Permit No. .(.rti,= - __g_ LJrU (Complete in Duplicate) 3 v -(p� This Permit Expires 1 Year From Date Issued Da+e 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. JOB ADDRESS AN CATION- �._ --------------------- ,----v Owner's Name--- -------/ t -AA1T�------------------------------------ --------------------------------------------- Phone---------------------- - Address-----------------�- -----••------------------------------ ---------------------------------------------------------------------------------------------------- __________ Phone_ - Contractor's Name----------- ------'=; = xa-=�.1 = , k Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms _ Number of baths /-___ Lot size ______7r-__-_ -—____-�_-__-______ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water TabledU- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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.) eptic Tank- Distance from nearest well___4/D_A/_Distance from foundation----_,f49--------Material ___ .r�� ___________________ _ No. of compartments----,A-----------------Si,e_ . '6--------Liquid ----Capacity—1 w2 ____ Dspas I Field: Distance from nearest well__4-./F Distance from foundation __ ____________Distance to nearest lot line----------------- ______-_____-_ Length of each line------ _- ______ __-__Width of trench - Number of lines------f_______ Type of filter material----/ZO_Ur----Depth of filter,material----Zcf � Total length-------��____�______________-_ _____ C ypa,,e Pit: Distance to nearest well---11gW4r____Distance from foundation----/0_ ____.Distance to nearest lot lin e_--�-�_/- _ Number of pits______/__________Lining material----� ce...Size: Diameter_25.✓" _-------Depth_---_��- 1: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----------------._-___.___________- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity- --------------------- gals. Privy: Distance from nearest well_ ------ ---------------------------------Distance from nearest buildin g------------------------------------------ ❑ Distance to nearest lot line---------------------------------- ------------------------------------------------------------------•--------------------------------------- Remodelingand/or repairing (describe)---------- ------------------------- -----------------------•------------------------------------------------------------------------------------------- ------------------------------------------- -------------------------------------------•--------------------------------------------------------------------•-----------------------•---------------------------------------- ------------ ------------------ ------------------------------------ --------- --------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I ave pr pared is appli tion and that the work will be done in accordance with San Joaquin County I ordinances, State laws rule and r ulatio of the San Joaquin Local Health District. (Signed) ;---- - -------- ----- r._Owner and/or Contractor) ------ By:-------------------------------------------------------------------- ------ .. . --c {Title)------ - - ----------- (Plot plan, showing size of lot, location of system in afion to wells, buildings c., can be plat- on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- � -Q�� DATE -�� - REVIEWEDBY---------------------------------------------------------------- ------------------------------------------------ --•--- DATE------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations /or recommendations:--------------- , -- - -----------------------------------------------------•-------- -------------------------- --- -- ----- -------------- a -�" -------- ----- -----------------� ---•------------- ��-� --------------------------------------------------------------- --------------------------------------------------------------------------------• --------------------------------------------------------------------------- FINAL INSPEC - - --- -- �- Date- .-/— 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.