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AU APPLICATION FOR SANITATION PERMIT Permit No./ �- (Complete in DuAf icefe) This Permilt Ex fres i Year From Date Issued Date Issued __ 7et-S_ r/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. i This application is made,in .compliance with County Ordinance No. 549. /" f 3 3 � `3� ` JOB ADDRESS AND LOCA ION 1 I -- - - - -- - ------Owner's Name ------- Addre ----- ----- ---------- Phone-, one - ss_ - ----- ----- Contractor's Name •----- ---- ---------------- ----------•-------------------------------------. Phone ----------•----•------------------- nsta anon will serve: Residence ------ �" [ Apartment Hou se��Commercial� ❑ .Trailer Court ❑ -Motel 1 Number of living units: __1 Number of bedrooms ._.____" ry❑ Other ' Water Supply: Public is s+em Num of bbaths - Lot size -_-- _7 c�--r-1__ PPY� Y Y ❑ Private pe t - ----- ------ - `] Y ❑ Communi# system /^ �eJ Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Depth tCla Learnafer able __-.___ ft, [ a t- �' _ Previxous Application Made:.,Yes � - Y ❑ Clay ❑ Adobe ❑ Hardpan ❑ No� ' New Construction: Yes � No ❑ FHA/VA: Yes ❑ No ❑. STYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200F feet.) Septic Tank: Distance from nearest well",.�(%----- Distance from fou dation__._ __- No. of compartments------- r� 10 -------.Mater I------ S}ze.__X - Liquid depth-."----- } Disposal Field: from nearest well.-� Capacity_.__� --------- Distance d Distance from foundation_--"�0-- -Distance to nearest log,c5 'Number of lines .______"�" --- - ---- ----- Length of each line _---- - -�� Wrdth of trench---------"--_-- / Type of filter material- __._ --- epth of filter material --- -- Total length__-___.___-__" __ __________ Seepage Pit: Distance to nearest well ________________�---Distance from foundation_- _ tGl '.__ -__"',.Distance to nearest lot line -__"_____________ ❑ .4 Number of pits----------- ------ Lining material--- " ! Size: Diameter_-- ------------------ De th------------------------- •-• Cesspool: Distance from nearest well_- ---_--_ Distance from foundation -_"."- p ❑ Size: Diameter ----A "- - Lining material. --------"----- ------ Depth -- ------------------- Liquid Capacity--------'------------------- Y� Distance from nearest well-__..___• ` :----------- gals. - Distance from nearest building___-"-_ "-___.__ Distance to nearest lot line -------------- ---------------1------- ------..----- lin and/or re airing "{clescri e)- ------------ ' .j' ------------------------------- - lP _ ------------- --- - ------ Y =---------•- ---------- -------•--- ------ ----------------------- _----------�--- + .�•.. ify that I have prepared this application and that the w 1 hereby certowill be done' in accordance with San Joaquin County rk \ 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed)_./ Plot Ian v {Owner and/or Contractor) _, . --------------------------- --- -., {Ti+le)=------------ . . . __ p ,showing size of lot, location of system m relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE .ONLY APPLICATION ACCEPTED BY_"_-"__-_--""_-_ _ - --------------------------------- I-- ---TDAREVIEWED BY ---------------------------- "-_--- `----------------- ------ BUILDING PERMIT ISSUED---------------------------------------------`-------------- ' ------------• - _ ------------------------- • �- Altera#ions and/or recommendations:_.. ' a �1 T//E. -... _ -- _7 ------------� � g � - --- ---- ` ------- 7 ` - __ ----------------- o t----- x Y- �- --- ------ -----------�- sem-f:. �,� .":6 - ---- -. FINAL INSPECTION BY: =--------------- ----------------- Date . 4�--------------------------------------------- 'SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SOUM American Street 300 West Oak Street Stockton, California Lodi, California ES -9-2M Revised 8-'59 F.P.CO. *. - - _ 132 Sycamore Street 814 North "C" Street Manteca, California Tracy, California