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APPLICATION FOR SANITATION PERMIT Permit No. .._./Y (Complefe in Duplicate) Date Issued .__�_- -----_-- -. l 44,.-2-50 . Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herBin described. This application. -is.made.,in_compliance with County O inanc No. 49. __� rj�.2 5: 6 "1G-x__5—'7 _f rt sr JOB ADDRESS AND LO ATION____ S (� - ---- ---.... -------------------------------- Owner's Name------------ '✓f - f l•!�t'I�1ge�?'��---- ------- �- Phone -------------•------------- Address---------------------------------: . l_�l --------------------------------- Contractor's Name ------ - ------------- Phone Installation will serve: Residence 2--_-Apartment House ❑ Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ // rI Number of living units: . .____ umber of bedrooms __!-__- Number of baths /__ Lot size --_��_--_/r-.�_0_0 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand [l Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe E❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes �ZE] FHA/VPS; Yes ❑ No ❑ TYPE OF INSTALLATION: AND SPECIFICATIONS: (No septic tank or'ce spool permitted if publig sewer is available within 200 feet.) Septic Tank: Distance from nearest well._ �______._Distanc f o founcLi*on__ ` �� ----------.Mater:al--------- ------------------ •----- No. of compartments--___._._ Size__ _V- ---' ,__.Liquid de fh_.--____----------------Ca acit ._ Disposal Field: Distance from nearest weII.9D_------Distance from foundation___._ —J ;rte-___-._-Distance to nearest lot line---- fzn --�''1'""�c Number of lines_______ _____ ____ __-__Length of each line______411_6) Width of trench_.__ Type of filter material___ __ ______ __ ___Depth of filter material_____I$----------Tota! length_______ _Q___-____----,_- Seepage Pit: Distance to nearest well-----------_----------Distance from foundation___________________.Dis#anee to nearest lot line----------------- rn ❑ Number of pits. Lining material 4- -------Size: Diameter-----------------------Depth------------------------------• _ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material____-.__-_.__.___.---- ❑ Size: Diameter--------------_--------------------------Depth ------------------------------------- ---------Liquid Capacity--- ------------------------gals. Privy: D;stancekfrom.nearest-well___.---------------- -----------------------Distance from nearest building---- ------- ❑ Distance to nearest lot line__.___.._________________ ---------------------------------------- Remodeling and/or repairing: (describe};---------.------- ___ # { �;.._ ----------••--------•---------------•------------------- - --- ------ ordin ==------•---------------------------------•------------- ------ ! hereby certify that I have prepared this application and ifhaf the work wifl be done in accordance with San Joaquin County antes, State laws, and rules and regulations of the San Joaquin Local Health District: (Signed) -------- ---- ------------- - _ r ( ner and/or Contractor. -------- --- - -By:-------------- ----------- -------------------------- --------(Title)------------- -----------------------•------ (Plot plan, showing size o lot,;location of'system in relation to wells, buildings, etc., can be placed on reverse side]. FO AR ENT US NLY Ill Z APPLICATION ACCEPTED BY ---------- -- --- --- . ----- ------- -------- DATE ----------------------- BUILDING PERMIT ISSUED-------- ------- --------------------------------------- -------------------------------------- DATE---------------------------- -------------------------------------------------------------------------------------- DATE---------- Alterations and/or recommendations_________ 11 ----------'--------------------•-------------------•----------------------------------------------------------------------- =.� i -------------•----•-------- ---------------•.............. ____-_-___'..______________________________________________...........-----------___._______.___.___..___-«_________.._____..___ "T___-______.__.K______ ...________ ___ ..____________________________________________ ------------------------------------------- FINAL ________________________ ___ _FINAL INSPECTION 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, California Manteca, California Tracy, California ES---9-2M Revisea 1.57 F-?.CO. r � f