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I C-0 1'3 so n r o5a y2 APPLICATION FOR SANITATION PERMIT Permit No. .. :2..�1 (Complete in Duplicate) Date Issued .._ This Permit Expires 1 Year From Date Issued ..._... �_:_ ,t 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. 5549.. � ________________ -------------------------------------------------------- JOB ADDRES_.S•J jAALOC TION_�._Vr -L3_----___4T.. �lJlOwner's Name- ---- --------- --------- �- -------- ------------------ - Address---- _ l ------ _. i _ ---- 'J Contractor's Name--------- -- ............... .... ---------------------------------------------------------------------------- Phon -----------------........------.-- Installation will serve: Residence 0( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -17 Number of living nits: .1---- Number of bedrooms ----�__ Number of baths .__/--- Lot size _--_ ----- k1- ........................... Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -_7_.Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ' Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Ye9,� No ❑ FHA/VA: Yes ElNo� TYPE OF INSTALLATION AND SPECIFICATIONS: 11 '' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .�� Septic Tank: Distance from nearest well -D f Distance fr foundati -/.tw_ ._------.Mat ri4l----- ------------------------ No. of compartments _-.Size _k- _ _.Liquid de th_____'� ___Ca Capacity Q p q P. P y--_ ----- ---- v.1 Disposal Field: Distance from nearest well._��DDistance from foundati n...�_, ---------Distance to nearest lo�t,,IJJ'ne--- _.. Number of lines___:_.____ Length of each line I-i-f.Width of trench.-_ `�`�------------------- Type of filter mate ria l__ ____._ ._ _ epth of filter material--------/�__.--__Total length_-__----__-.r_Q_____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- R 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):------------------------------------------------------------------------------------------------ -------------------------------------------------------- --------------•--•-------•----------.--•---------------------•-•---------------------------------------------•-----------------••----------------------••-------------------...................... ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ---- -- --- ----------- --- ------------------------------------------------------------------------(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 APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------- DATE.---------------------------------------------------------- REVIEWEDBY---------------------------------------------------------- >-'" - ---------------------------------- DATE -------------- BUILDING PERMIT ISSUED. -------------- DATE. _""` ". ? - -----?__r------------- Alterations and/or recommendations-------------- --------------------------------------------- ------------------------------ ------------------------------------------------------------------- ----------- •-----..----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------------------------------------------ -_ --------- ----------- -------- ------------------------------------------------------/--"---------------- -------------------- FINAL INSPECTION BY---------------- ----------- Date---------- ,?,_'.. 7"''6 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.