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APPLICATION FOR SANITATION PERMIT Permit No. ...l..a .Z l {Compete in Duplit cae} ��- Date Issued ' This Permit Expires 1 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 LOCATI N____�` �--rm`�� - --- - -- ---�-=---- ----------------- _ Owner's Name--------------------------- r - q� --- Phone- 0---.(-731-9 F Address---•-•---------------:----- �� '"` L ----- b 1 � � /�� Contractor's Name--• ...... ------ ------- ----•-•------- Phone-405M. -•----- Installation will serve: Residence Apartment House ❑ Com ercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- I----__'Number of bedrooms -A- Number of baths ___r___ Lot size __`� �__ ��---------- ------ 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 ❑ No New Construction: Yes x No ❑ FHA/VA: Yes ❑ Not I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 16 No. of compartmentst , Barest well----�62_- Disfance from f undation____. -"______-.Mate iaL___._ __ -------------------------- Sep ...". is Tank: V Distance from n _______ .__Size __• �� -- QLiquid depth.. __ Capacity."� -d_ �C -^Dis o al Field: Distance from nearest ji .__�f .____-Distance from foundation____ ad__..__.Distance to nearest lot line___ _________Number of lines---•------ ---------- ----Length of each' line:------- _" _ Width of trench.--------A-- ---------- r Type of filter material_---- Depth of filter material:___=I -�� _----Total length---------�_-5 _.r_________________ i Seepage Pit: Distance to nearest well...... .......:._:Distance from foundation--------------------Distance to nearest lot line_____.________.__ Number of its----------------------Lining material--------------------- -Size: Diameter------------- - -------Depth--------------------------------- ❑ p 1 ______.___- _Distance fro foundation_______ __________fining material_.___ ...-_____________--_-___._. Cesspool: Distance from nearest well . F1 Size: Diameter_I-----------------------------------Depth----------I-----------------------------------------Liquid Capacity---------------------------gals. I Distance from nearest building Privy: Distance from nearest well----------------- ------------- ----------- - ----------------------------------- ------------------ --------------------- ------------- ❑ Distance to nearest loft line--------- ------------------------ --- { Remodeling and/or repairing (describe)--------------------------------------------------------------- '`--------------------------------------"---------------------- ------------------- 1 ------------------- - --- -----------•---------- ---------------- ------------------------------------------------------------•____________. ..__------------------------------------- ------------------- _____________________________ ____________________________________________ _____________ _'___.____..__.________._.____ _____.___ __________________-.--________________--__________________--.---___________.______---____________._---____.____________-.___.-_______-_...________-. I hereby certify that l have prepared this application and 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-bistrict. Iy-----`------------------�j --------------------------------------.+ad/or Contractor) (Signed)---- -f- - , , �,.. f By:----------------------•----------------•----------------------------------- ---- ------- ------(Title)-------%--------------------------------------- - ---- --------- (Plot plan, showing size of lot, location of system in relation to wells;buildings, etc., can be placed on reverse side). i, I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------- -------------- ----------------------------------------- DATE '_ "' °` ' ' REVIEWED BY--------------------------------------------------- ---------------------------------------'------------------------------- DATE-----------------------"----------------------------------- BUILDING -------------------------------- BUILDINGPERMIT ISSUED------- ---------------------------- ------------------------ ------------------------ --------------- DATE------------------------------------------------------- xn-•---------------•---- •------------ Alterations and/or recommendations__________________________"----- ------------------�-�- -"---------" "' ' + 3 ___________________________"-_.___-_.------_....______.__..----____. s 1• ____________________________________________________________________________________ ....__.____..______________________.____-________--._______-__-.__.._---___.______-_._..________.____.---_._._________-.____-__..________-__ --------------------------------------------------------------____--------------------------------------------_--------------------------__ ----------------------------------_-----------_---------------------- ----- ------ -----------.--------------_._.__ _______.___._._.._._-__.______-.__...__ - ___-____..-._.__..________._...___-_ -------------------------- FINAL INSPECTIO N BY __ -___.. _ -- ` --------- ----------- ) Date__ --- ----------------------- ------- --------------------------------- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street \ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, CaliforniaManteca, California Tracy, California ES-9 2M Revised S-'59 F,P,Cc.