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q7 1 ' APPLICATION FOR SANITATION PERMIT Permit No. _ . (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 A LOC�ATIO.N-.-,-,- .1.1.1 - ------- - ----------------------- Owner's NameRfU` _____- ------ Phone-------- .......................... Address------ .•.�SP ----------••••-- ---•-----------------• ------------------------------------------------------------------------------------------- Contractor's Name--- --- ------•------•----------•---•-----•------------------------------------------•---•---- Phone................................... Installation will serve: Re idence/[X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./--__ Number of bedrooms ._Z_ Number of baths !--__ Lot size ......fl_. _1_c��_r7•------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table .LQ 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 No ❑ FHA/VA: Yes ❑ Nok TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0,p \ Septic Tank: Distance from nearest well__�1�__nP:7�[Sistance from found ion-_-_-_l_-fl.__.._..Materl l.- -----------'_�-______ - -____. No. of compartments__-_-A----------------Size..0,X__�.X. Liquid depth---------- �ry,/_Capacity.... _. .___ Disposal Field: Distance from nearest well.45—© f Distance from foundatio __...�_ ____¢ Distance to nearest line.____j ....... Number of lines--_-_�____-y---__---___ _•Length of each line _ r___ ___'l1 /Vidth of trench , _.. Type of filter material__5_�. .}Depth of filter material______ ____-_____Total length------f,.15 ................... Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_____-----------_ ❑ Number of pits---.------------------Lining material-----------------------Size: Diameter-------------- --------Depth--------------------------------- Cesspool: ____---_-_____•-.-_-- _____.Cesspool: Distance from nearest well------------.....Distance from foundation--------------------Lining material_:__________________________________. ❑ Size: Diameter-------------------------------------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-__-__--__.-_.__--_------_-_--_.-__-._. ❑ Distance to nearest lot line----------- -------------------------------------------•----------------------� ---•--------•---------------------•-•------------------- fLLQ rr ► /� � Re/podeli g and/ r*airing 'descri _ _.Q !4.�.._ 7,0.••..&.J.C..tPC$t_ Q t r �' Vic/4.991 1-- - k� ,,P,�----�r--�---�--- 7.�f� • --------------------------------------------------------------- --------_------lJ-.-._•_---_-----_ ------------------------ ---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed) _ 1.1.W_ _ ------------------------------------------------------------------------------------------------(Owner and/or Contractor) By: (Title). (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------------------- -----• DATE.................... t REVIEWED BY --- ---- -- --�- �---,�r- - DATE----------,'�,�� 7'� l BUILDING PERMIT ISSUED -- ---- -•--- r__- - DATE ------------------------------ -- Alterations and/or recommendations:---------------------------------------------------------------------................................................................................... ------ ------------------------------------------------------------------------------------------------------------------ ----------------------------------------•----------•----------------------------•-------------•--------- ---------------------------------------------•------ ------------------------------------------------------------------------------------------------_....---•-••-•---••---.....••-•------•-------•--------••------•--•-•- ---------------------- ---- - ............ ----------------- ------------------•-------------------- ------------------------------------------------------ FINAL INSPECTION BY:----------- --- Date------------------F--7-------�-/----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.