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APPLICATION FOR SANITATION PERMIT Permit No. ..1Q... . (Complete in Duplicate) Date Issued -__-1--71 j::5 This Permit Expires 1 Year From 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. ai JOB ADDRESS AN LOCATIIOOKS5� ,-- --- ------- --,,- ss ------------t-------------/------------ --- ............ Owner's Name------ . --- ....;; ......... --------- -------------- ------------- Phone------ .................. Address-•------•-••------•---• �...� -•4-'-.-��--/Z---e_ �"" Lac.-. -D---- Contractor's Name��'� f' Phone{ -� Q:7" C Installation will serve: Residence Jj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms __/_ Number of baths ---/--- Lot size ...._.__. Q___°___ •-j7�..-`---____--- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe id Hardpan ❑ Previous Application Made: Yes ❑ NoJ2 _New Construction: YesjW__No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.yll,", W Septic Tank: Distance from nearest well.1-0.0_1---Distance from foundation__".__Material__________________________________________ No. of compartments_____ _____`_Size...w -Ax._`�tLiquid dept-_-_---J-- !____Capacity....__ O Disposal Field: Distance from nearest well--/_____4!�---Distance from foundation ./J�_____.Distance to nearest�lqot line_________________ O Number of lines_._--__I__ __________ _ Length of each line------ ©__________.Width of trench.---C�.� ............. Type of filter material_ �_��-�_S____Depth of filter material_______ "__--Total length_________________C00_ ........... Seepage 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--------- --•------------------------------------•-------------------------------------------------------•---------------------------------- oo -- �.J 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 laws, ak rules andwreglations of the San Joaquin ocal H Ith District. , ��- ----- (Signed)------�-i""=-- ---------- -� �^�----- ---- - --- - --------�--- - -----� r Contractor). By:.................................................................... -- - ---- --------- (rifle)---------------------- ---------------------- - -- --------- (Plot plan, showing size of lot, location of system in rel o wells, buildi , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ----- ---------- DATE----- --•---. ..f ------------------------- REVIEWEDBY-------------------------------------------------- ---- --- ---- ------ DATE---- <c .. ...... ------------------------------- BUILDINGPERMIT ISSUED ------------------------------------------------------.- DATE------------------------------------------------------------- ---and/or recommendations----------------------------- ...................................................................------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------........................................ ---------------------------------------------------------------- ----------- ------------- ---------------------------------------------------------•----------------------------------------------------------------------- ---------------- ------- --------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY------------- ------•---------------------------- Date------------ - f� 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.