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APPLICATION FOR SANITATION PERMIT Permit No. 7/ (Complete ini Duplicate) 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 instal the work herein described. This application is made in compliance with County Ordinance No; 549. ,`-7 j JOB ADDRESS AND LOCATION......LOt---0__7-r ---------v t 1ft-&-da...ms r1a .(0-------/ -------------- ---------------- Owner's Name----.--_ �0601id la__-FiLwa.�- _ �-----------••--------------------------------------- -------------------- - -- --------- - Phone------------------------•------•---- Addressf _IIkC ' ' ---------------------------•-----------------------•-•-----.-••---•-------------------- Contractor's Name-------- # 1' AtIC `-sow t --- *.vi a--- ----- ------------------•---- --- ------ ---- Phone---- Installation will serve: Residence [11 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __-- Number of bedrooms __ Number of,baths I______ Lot size ____ _ ------"V Water Supply: Public system ❑ Community system j. Private ❑ Depth to Water Table .4lS_ 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 X] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: i .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) FA No. of com artments_._ P� from foundation_' Material I I --------------------- ---------- _________________ i Septic Tank: Distance from nearest well SD-izea�Ce __.! ------------Liquid depth-_ �______ _________Capacity.. __________ Disposal Field: Distance from nearest well-------- .--------Distance from foundation____ _____._.Distarsce to nearest lot line___ : .______. Number of lines----"------------------------____Length ofeach line____._?*____:___`_____.Width of trench.__,-4--------------------------- Type of filter material___ r0 __Depth,of filter material-___1 __________Total, length---150,.__-_______-_________ Seepage Pit: Distance to nearest well-----------XX-----Distance'if rom foundation____10-----------Distance to nearest lot line... nV 4 Number of pits____:___.---.__- Lining maferial__-_ _ft*-------Size: Diameter_—:14-.. �_-..Depth__ #�#P___ �#_____ Cesspool: Distance from nearest well-----------------Distance from foundation---.---------_.: _Lining material__-.-.. __-___-______..___________. Size: Diameter--------------------------------------De th--------------------- ---------------------------Li uid Capacity gals. Privy -------------Distance from nearest building------------------------------------ --. Distance from nearest well___.____________________________---_ ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- ------------- �. Remodeling and/or repairing (describe):.-- ' - ------ ---------------------------------------- ---- - ------------••---•------------------------------------------------------------- ---- --------------------•- •-------------------------------------------------------- --------------------------------------------------- --------------------------------------------------- --------- ----------------------------------------------•------------------------------ ---------------------- ----------- - I hereby certify that I have prepared this application end 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. l (Signed) ------------------------- -----------Owner and/or Contractor By:----------------------------------------------- ---"------------------------------------(Title)------Omm---------------------------- --- --------- (Plot plan, showing size of lot, locati f system in relation to wells, buildings, etc., can be placed on reverse side). : 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - - •--- ----------------------- .DATE----,-.P_ 1� d-------------------------- REVIEWEDBY-------------------------------- ------ ------ ----------------------------•------ •---------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------------------•------------------- 1 Alterations and/or recommendations t_______-----__________-- _--. - w ' --------- - ----------------------------- ---- -- -------- ------ -------------------------------- -------------------- ------- ------ -- ---- - { ._- --- --- 7 -- -------- i --•------------------------- ---------------------------------------------------•------------------------------ 1. --------------------------------- --- ... --•------------ 1 ---------------------•----------- FINAL INSPECTION BY:.. --'/---------------- Date----- r ---- 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 J ES-9 2M Revised 5-'59 F-P.Co. it