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11 APPLICATION FOR SANITATION PERMIT Permit No.,_fl.. - Z (Complete in Duplicate) 1 _ Date Issued __.. -__---� f ,s- �A-4. d ; 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 withCountyOrdnance No. 549. F # JOB ADDRESS AND LOCATION--------1-_!_1J------- ------------------------------------------------- - ------------- ----- - ---------- Phone --33 33� 1 Owner's Name---------��p i � '�' - i Address------------_------ --------------------------------------------------------------------- ---------------------=--------------•-------------------------------------------------------- Contractor's Name----------------------- ' i ------•--------- ------------- Phone_. _ �. ts ---• Installation will serve: Residence ��partment. House ❑�.Commerciah❑ Trailer Court ❑ Motel.❑ Other ❑ i ° � • Number of living units: _ ?- Number of bedrooms ._yrNumber of baths _-�_ Lot size __ -.1__. --� ------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table '�7!P- ft. Character of soil to a depth of 3 feet: Sand E] r Grav,el,❑ Sandy Loam L] Clay Loam ❑ Clay ❑ Adobeardpan C] Previous Application Made: Yes ❑ D No New Construction: Yes ❑ No [ FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPEC11 IFICATIONS: I (No septic tank.or cesspool'permitted if public sewer is available within 200 feet.) ! ii 4: Distance from nearest well_________________Distance from foundation -----------------.________- _ ________.____ ..Ca at Y oprts---------- ---------------Size------------------------ Liquid dePth__.__ u i _Distance from foundation-_____- -------Distance to ne rest lot line"--___-_____---. oI fild: Distance from well -Number of lines----- ---------------------------- Length of each line--------------`--------------.Width of trench-------.------.--- %--------------- Type of filter matetial�^-:'-- --nt-Depth-of�-filter-material___-:_____"_-_____.Total length___ ,__""____________________ I. t .. r.. i Distance,_from foundation___�--------__Distan;� to nearest lot line---A__._______• Seepage Pit: Distance to nearest well_____-.____- , r ! ' Number of pi fs.-------I----------Lining material--- - --6.C/ ----.Size: Diameter----J� 3-----------De th--- --��-------------------• Cesspool: Distance from nearest well-________________Distance from foundation__-._._.____- -"-_Lining_materialt___-_-__ __-.___--____._____-_____ ❑ Size: Diametet_'----------- Depth --- : ==-Liquid Capacity_._..--i----------- gals. • from-nearestI' ° '-"'.____._--_Dishance from nearest building Privy: Distance well--"< ----------- •--_•..___ ------=------------ ---------------------------El ------------------- -.. Distance to nearest lottline-.-. -`'_:_____----- r 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 lar�r ' and rules and.regulations of the San Joaquin Local Health District. t i (Signed)_ �_� - - _ - ------------=---------{Owner and/or Contrac Contractor) tle)B - (T (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r I FOR DEPARTMENT USE ONLY l p APPLICATION ACCEPTED BY---(fx C �/ �-- --------------•------------- DATE "'/GY d REVIEWEDBY--------------------------------`-------------- ---- ------------------------ -------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-----------4------------------------------------ -------- ---------------------------------------- DATE------------------------------------------------------------- - Alterations and/or recommendations* ----------.--�--------- -- "---�--"--------------------------- -------------- ------- ------- -------------------------- ,V-'� --- -- ----------------- ----------------------------------------------------------------------------------------------------------------------- -------------------- I •--------------- FINAL INSPECTION BY:_4V._•_.e.... �" r'- " � Date----- -----> _' E2_`._ ------------------------------ 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.