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1 65 q -7 k,Gtr APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1 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 LOCATION---` 7__ ,-J• ` C� Owner's Name --- ---------- -- ---------- ------ - Phone ------------- --------------------------- Address 'r ------------------------------------------------------------------------------------- -�------ �.5© Contractor's Name----------- - -- ----- -- ----------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residenc Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Number of living units: _ ____ Number of bedrooms ___�__ Number of baths ___ _ Lot size _� ._, _____�..�_________________ Water Supply: Public system ❑ Community systemPrivate F] Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑A Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes ❑ No)19 FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeOic Tank- Distance from nearest well_________________Distance from foundation--------------------Material_-__-______.__-.___--___-________ No. of compartments--------------- ------- ize--------------------------------Liquid depth--------------------------Capacity---- ___-- Disposal Fiel Distance from nearest we ance from foundation_ILO _.__.Distance to nearest lot Ii eye-------------- W Number of lines____a��._ J--_____ _______Length of each line--3_ -------------- _33 Al Width of trench_.__. _�r'_________________ Type of filter material__5_7-_ Depth of filter material___--___-/_O_.-----Total length---------=57-A------------------- (� eepage Pit: Distance to nearest well----------------------Distance from foundation___-______-________.Distance to nearest lot line__.-_--.-_--_____ ❑ Number of pits______________________Lining material-----------------------Size: Diameter__.-____--___---_.-___Depth__..__.--.._____-___-_-.-_-______ 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----------------------------------------------------------- ---------------------------•---------------------------------------------------- Remodeling and/or repairing (describe):-- .�.�•----C--do6j"'sw -----------------------------------------------------•-----------------------------------------------------•-•--•---------------------------------------------- --------------------------------------------•---------------- _______ r--- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawns, and rules and regulations of the San Joaquin Local Health District. [Signed)--?--\ � -L. _. ._------------ ------------ ---- --•------- ----------------------------------------------------------------(Owner and/or Contractor) ice By:----------7--1-4-71 ....... --(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------------------- -� -------------------- REVIEWED BY------ -------------- ------------------------------------- ----- --- ------ -------- - DATE__-? l� BUILDING PERMIT ISSUED........................................ -- DATE------------------------------------------------------------ Alterations and/or recommendations------------------------------- --------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------•-•-------•-- -------------•--------------------------------------------------------------•---------------------------------------------------------------•--------- ------------------ -----••---------------........................... -----------------------------•---------------------------------------------------------------------------------------------------------------•----••- -------------•-------- -------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------••------------------ ----------------------------------------------------------- '. 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.P.CO.