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� � APPLICATION FOR SANITATION PERMIT Permit No. 1...�..�...f. ��. K' (Complete plete in Duplicate) r f._D .4ja This Permit Expires 1 Year From Date Issued Date Issued -__ Ai Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance with County Ordinance No. 549. 1.� L_ � E � JOB ADDRESS AND LOCATiO _��Cl__-I_ebr9fit/ar-.�iV�t.�-- t�---=r-- Q----.:�---- ��---------------- �NV _Vp------------- Owner's Name __��..... _.... .. ........�--------------------------------------------------------------------------------- Phone._ ------------------------------ Address ----- 91 .Address1 ��wi �r Contractor's Name.-Yl�.�_.__ - ----------------------------------------- --------------------------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ _____ Number of bedrooms _ ___ ._. .....x._. ........... �' Number of baths _�.._ Lot size ____C; ..� Water Supply: Public system (..Community system JjC Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0e,—Clay ❑ Adobe& Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes,%,No ❑ 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 weII.1Q_�-_--- Distance from foundation -----40, -----.Material----.'L__'_- -- ,r�------- ----- r� No. of compartments -2 ":! 3<<e °_',_--Li Liquid de th__. -- - Capacity....oa * P Size 3 t� q P. ------ Disposal Field: Distance from nearest we, II D!? "__._ Distance from foundation__ew;�. 67.....Distance to nearest lot line ... �r'.... W ial Number of line_ _________ ____ _ Length of each lin Width of trench ___�,'_f�''!................ Q Type of filter material. _._ __.Depth of filter mat ._ _-_Total length ...... O Seepage Pit: Distance to nearest well ---------------------- Distance from found tion .................... Distance to nearest lot line ----------------- El Number of pits______________________ Lining material --------- ._.___.___._ -Size: Diameter ----------- _----------- Depth ______-__________-_-_______._--__ Cesspool: Distance from nearest well ----------------- Distance from f4rdation---------------- __-Lining material ---- .__-____-_-________-._.___---.--. ❑ Size: Diameter -------------------------------------- Depth ---------------------------------------------------Liquid Capacity -------- .................... gals. Privy: Distance from nearest well --------------------------------------j from nearest building_-____-__________________--_________... ❑ Distance to nearest lot line ---------------------------------------- -•- ------------------------------------•---------=----- •---------•---------------------.--.-.-.-.-.-.-.-.- Remodelin9 and/or repairing describe):__.____ ------................. . -------------------------------------------------------•---------------------------•------------------------------•-------------------------------------•--------------'----------------•---------------_....--------------- m ----------------------- ---------------------------------------------------------------------------------------------------------------------•------------------------------------------...-.-------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Si ned 9 )-^�- �'(-'¢-��}�-------�-'-�--_-�------ ---y- l-1---- --�--�-%---�---/�-�------------------------------------------ ( Contractor] By:----------------------------------------------------------------------------------------- - - A/ -r---'✓ •!u ----(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation t ells, buildings,, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------------- ---------- C; DATE .}L'�_a REVIEWED BY ------ DATE ------- ---------------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------- --------------------------------------- DATE ------------------------------------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------_. - ---- ------------- --------------- -------- z - FINALINSPECTION BY------------- -------- -- ------ Date--- - ----------------------------------- ------------- - ------------ SAN--------- 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 8-'59 F.P.Co.