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L APPLICATION FOR SANITATION PERM � Permit No. ...�'�_S___�__d (Complete in Duplicate) This Permit Expires 1 Year From Date Issue Date Issued .... Application is hereby made to the San Joaquin Local Health District for a permjt to ns�cf4irs install the work herein described. This application is made in compliance with County Ordinance No. S49. ,//./_2,eJ `7 JOB ADDRESS AND LOCATION............ ------- --------------- [ ---------- ��r-- ` t Owners Name---------- �"r TL ------------ � �'j'�� r-�'� ^- — ----------------------=Phone---- Address--_--------------��.�..-----� ��C'..-V------- �� r ----------------------------------------------------------------------------------------- Contractor's Name----------f.� �d t`Q'-------------------------------------------------------------------------------------•----- ----------------- Phone------------------....------------ Installation will serve: Residence UE[, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..- - Number of bedrooms __/__ Number of baths ----/__ Lot size -..-------------'y!!-...... _.Q................. Water Supply: Public system Community system ❑ Private ❑ Depth 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 ❑ N0New Construction: Yes No ❑ FHANA: 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 ..._Distance from foundation-----/�Z--------Material .... .z .!�..o .... No. of compartments--------;?�---------------Size----= X..1�-,X3----------Liquid depth--------- --------------Capacity-------G- � f 4 Disposal Fi81d: Distance from nearest well....`t"`°_..Distance from foundation_._...------- .. .Distance to nearest-lot line------I--..._.. Number of lines---------------/�__.-....__--___Length of each line---------- - _ --._-__.Width of trench.---..---- -. ---------------- Type --- --------- Type of filter material-___.- Depth of filter material-----Z_r.........Total length-------------I ------------------- Seepage `.-.._...-------.Seepage Pit: Distance to nearest well___' Distance from foundation----_... ._...Distance to nearest lot line..-..--5.....- -. Ed" Number of pits------ -----------Lining material.. art• ... Size: Diameter-',_k._f-�t�Depth_.._._..�`_-----...__.__- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- n Size: Diameter---- ---------------------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals, Priv Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------ -------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------- -- ------------------------------------------------------------------------- -------------------------------------------------------- r-' ----------------------------------------------•--------------------....------------------------------------------------------------------•------------•--------- ------------------------------------------------------------- ---------- -- --- --------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and miles and regulations of the San Joaquin Local Health District. (Signed)-. zj r' J ............................._-_-.-..._--______.- Owner and/or Contractor) a SY= ='}�---- z a y---------------------------s-----(Title)----- ` ------- ...... ................ (Plot plan, showing size of lot, location of systei in relation toywells, buildings, etc., can 6e plat d on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -------------------------------- DATE------Al--7 o-------------------------------- REVIEWED BY------------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------------- ---------------- ------ DATE------------------------------------------------------------- Alterations and/or recommends#ions:r- :: ------------ .......--------------- -------- -•----------------------------------- -----------------------------•--------------------------------------------------------------------------------------------------------------------------------------------...------------------------------------------ ------------- ------- ---------- ------------ ---•-- -----------------------------------•--------------------------------------------------------------------------- FINAL INSPECTION BY:�'�--- - - -- Date--------------- l...-----� -.(Q[� ----- - -=- -- - -------------------------- 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 Fe,lsed 8-'59 F.P.Co.