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APPLICATION FOR SANITATION PERMIT Permit No. .1 �_ ` 4 (Complete in Duplicate) 2 Date issued ___ This'Permit Expires I Year From Date 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.AND LOCATION....1�i- 7-_,� t____iy_ ____-...:.:0 t—-. ---------- ----•---------------•------------ Owner's Name3 v �d i / ---------'--------- ------ --- ---------- Phone. -------------------- Address-_..---- -6-e----��Z __ _ ��-- --- ---------- I Contractor's Name----- 74-'D 4- �� 4_�l�J� � `` "`-`�°�------- Phone-----7�Zr-- 7 -• ---------- Installation will serve: Residence- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other q---CW-k ' Number of living units: __/____ Number of bedrooms __y Number of baths __ Lot size _.____- �------------- Water Supply: Public:system Community system [:1Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoamJi�f__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.) Septic,Tank: Distance from nearest well_ Aw ___Distance from foundation__/V_�_______.Material __-__. `"'-- ----------- No. of compartments-.�_-----_------------Size__ `' '_-_Liquid depth____ _ ........ -r-_5'.-A Disposal Field: Distance from nearest well_A-Qom..-_Distance from foundation._..1�---------Distance to nearest lot line----/FS' Number of lines___. __-.a__�_____Length of each line________'___-_______.Width of trench.__ __ '!_________________ n ��77 Depth of filter materia3____-___ Total length ` Type of filter material_ t-dam;', -- p - -'� -- g � r Seepage Pit: Distance to nearest well------ 1_F-__Distance from foundation------Z_--------.Distance to nearest lot line_____lJ � Number of its.-_ // Lining material.__!-_.__ -Size: Diameter___-_„3_3.��.----_Depth__. _____________ P f - i F Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-- .---------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance•from nearest building-------------------------------------___._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------ ---- ---- Remodeling and/or repairing (describe) f- c.c` e_ ��f ------------------------------- ------------------- ---=--------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be' done in accordance with San Joaquin Coun ordinances, State VQ, and rules and regulations of the San um Loc Health District. (Signed) - - '�! ----- ✓- - Qwrrer-assn/or Contractor) � f�/� By%_------------------------------------------------------------------------------ ----------•U�'-------------------------------(Title)---------------------------------------- --- --- -------------- (Plot plan, showing size of lot, location of system in rely on to wells, ESuildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- +" ' DATE v,W'.7 ' --------- REVIEWEDBY----------------------------------------------•--------------'-- ----------------- 4 -K.--- ---- -- --- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------- -------------------------------------------- ---------------------------- DATE---------------------- Alterationsand/or recommendations:---------------- --------------------=--------------•---------------------------•-----------------•--------------------------------------•--------- -------- ----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------•--------------------------------------------------------- FINAL INSPECTION BY:------ ------ -- ------------- =-l --- 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 ° Lt-9-2M Re�ised 8-'59 r.P.eo.