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_ U I APPLICATION FOR SANITATION PERMIT Permit No. ..f................... (Complete in Duplicate) � This Permit Expires 1 Year From Date Issued Date Issued . ___.__.__.a_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install te work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI ------ h+-'�&��-�/ /� Owner's Name--------� 1¢�� Phone.---•-------------------•----------- Address---------. ! ----- -----• -•---------------------------------• -----------------------------------------------------.....----------------------------------- Contractor's Name-------- '' ) ----------------------------------------- Phone. Installation will serve: Residence m`�_Apartment House [j Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: --/-- Number of bedrooms-_ Number of baths/-4-, Lot size .- _ `ti.�s..�.____________-_.___________ Water Supply: Public system E] Community system El � Private bepth to Water Table _ +� 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 J��o ❑ 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 __719----Distanceprom f yp dation____fV-______-Material____._ ve.J_ ' allo. of compartments... ._ ---------------Sizej (`„?4Liquid depth- _-- - �___-- Capacity__,� �� _ ~. ._ j `= Disposal Field: Distance .from nearest well__. _____-Distance from foundation___ : -------Distance to nearest lot--- ------------------ line__�_� U� 1 Length of each line-34 __- .. Type of filter m 9 . _`��Midth.of trench- - ---- Number of lines_ yp ateriai�_j7_ ___G_—Depth of filter material--f� _-`____Total lerigt�+.�_J _�________________ 16 Distance from foundation____ _________.Distance to nearest lot line_ Seepage Pit: Distance to nearest p well- _____-- � ne Number of pits---./fir\___.----Lining material_ P�etC_..Size: D:ameter--��-------------Depth-��--------------____-- Cesspool: Distance from nearest well-_.-,._._____Distance from foundation____________________Lining material-___.______________._________________ ❑ Size: Diameter__ -;- -------Depth---------------------- - Liquid Capacity gals. ---- 1 _________D:stance from nearest buildin Privy: Distance from near%est well_____..__ :1------------- ,9' ❑ Distance to nea rest lof,line--------------- ------- --- --------------------------- Remodeling and/or repairing (desc jibe):_`1., �.�. f I ----- -------------------- - --- --- f q. • --------------------------------------------------------=-- ;;------------------------------------ --------- ------------------------ -----------;;-----_------------------------------- - ! hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.'" } (Signed)_---------- ------ - `�= ------------------------------------ -- -(Ownep-arirdftr Contractor) '"' Title - ^� -------------- BY:---------------------------•--------------------- ,1��t < ------------- I ] ' � (Plot plan, showing size of lot, locati of system in relation to wells, buildings:etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY_. l� f'� '4 DATE `' " REVIEWEDBY----------------------------------------------------- , ------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ `---1------------------------------------------------------- ----- ----------- DATE--------------•-----"------------ --------------------------- Alterationsand/or recommendations:-------------- --------------------------------------------------- =:-------------------------------------------------------•--------------------------- ____.__.i: _.______.__� ___ ____—___________________ ------------- -------------------- ----------------- ----------------= ,r te ----------------------------------------------------------------------------------------------------------------- - ---------- ------ I ----6 FINAL INSPECTION BY:. - � ' �"L "'�� Date-- -r----�-- -�J-�- ---- --------------- 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 V59 F.P.Co.