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II APPLICATION FOR SANITATION PERMIT Permit No. _,!-Q_ (Complete in Duplicate - 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. /6 �-� - 7 i{ JOB ADDRES AN L CAT O .. - !-- �� s 1A Al t= cam a iQ°1 Owner's Name---------- = Ur = s?--------------- Phone --------------------•--------- Address--- -------- - ---- ContractorsName ----------- ----------�-----------------------------=----------------------------- Pirrone Installation will serve: Residence ff�- Apartment House 0" Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units.-' --/ Number of bedrooms _3__ Number ofbaths-_- ''Lot size _-- ---- ---------------------- ---__..---------------- Water Supply: Public sys+ern ElCommunity system [IPrivate [Depth to Water Table -'/,0 ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑.•Clay Loam ❑ Clay ❑ Adobe 2--H- �ardpan ❑ Previous Application Made- Yes ❑ No P<�Iew Construction: Yes [ o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) r ` Septic Tank: Distance from nearest well_ .___-Distance from foundation-----1/_D.......Materi9l--------------------------- ._---_Imil ❑� No. of compartmenfs-------,�__---------Size-__.� _- _ �--Liquid depth------ Capacity--�+t- l_ Disposal Field: Distance from nearest we4___S --.-_ -Distance,from foundation--- p�,,, (stance to nearest lot Gne_---5____-... �`�! Numb er of lines--_-__ —__________ ______ _ Length of each line---- � ___- -- idth of trench----_-_ - __---------� Type of fili Iter material--- �_/ -_ epth of filter material----� ._-------Total length--__-----------------/I,SZ--- Seepage Pit: Distance to nearest weff_� _,-_----Distance m fo ndation___--, v_-_-_-.Distance rto nearest lot line----s----�. Number of pits_i-___c�-------__Lining material__-_ Size: Diameter-----133---------Depth--..---_� 1--__-- Cesspool: Dis+ante from nearest well-----------------Distance from foundation----------.._---_-.Lining material-------------------_____--------❑ Size. Dia meter--------------- -------__---Depth--.--- ------ Liquid_ Capacit - -.r ga Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.-------__-_-----_-----------,- ❑ Distance to nearest lot line ' Remodeling and/or repairing';[describe]:---------------------------------------------------------------------•--------------------------I-------------------------------•----•------------------- 1 --;--- ------ ' -------- ------------------------I-------'-•-----------•---------------------------------------------------------------------------------------------- ------------------------------------------------------ I hereby certify that I hve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulatio of the San""J quip Latal ea}�District. (Signed 43•C. i 'C' - ------ - -------- �0 ner and/or Contractor) Y•-•------------ --- - ------------------------------------•---------------{Title) 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 ff APPLICATION ACCEPTED BY--- I ` ��'------- ------ ---------------------------------------==----------------- DATE-------Cr1---16- 57- --------------- --- -------- REVIE1/ti/ED BY =------- 11 ------------------------------ DATE BUILDING PERMIT ISSUED----=------------------------------------------------------------------------------------------------- DATE. i -------------------------- Alterations and/or recommend ations: ........ tT I� TH 5----- i �� ©_---------6�`lb� c --------------- •-------------------------------•--------- . ------------------------------------- FINAL -INSPECTIO BY:--- II Date-- _7---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT it I30 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 1.57 R .CO.