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f /10 APPLICATION FOR SANITATION PERMIT Permit No. ..../A/-6— (Complete in Duplicate) / This Permit Date Issued 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 he ein described. This application is made in compliance with County Ordinance No. 549. A �^ 1 . JOB ADDRESS VD LOCATION-- ----�.f' s ' 'G 'a / ---.......--------�" Owner's Name---- ------------ --------------- ---------- Phone.................................... Address --•-•---------- * -�--`�_� �r.:.:1 "� � e�± c?� .�a Contractor's Name---_ - `'c..--"` """ , � c------ Phone__! _A.7QT-.G Installation will serve: Residence . Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __x_-_ Number of bedrooms .Z--- Number of baths _l.._. Lot size ,.i--_- ._..,� ---�°^'"'_ ---- ----------------------- 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* Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes F-1 • No 1771 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � Septic Tank: Distance from nearest welLV.. Q__e__Distance from foundation.1_10_._.__..__.Material____-__�'- _____. _ � _._...__. No. of compartments----.2t-----------------Size- , �t _r rip��_-Liquid depth___��-'i-------Capacity---Folz......... Disposal Field: Distance from nearest well.-V_."'._.__Distance from foundation__-C-©�_....Di fiance to nearest lot line.... - _._._Length of each line-_44 d'.__-- edth of trench------------------ rr Number of lines__•.._________________ (� Type of filter material__ 4.1� .__Depth of filter material_-_-___-_-__Af,"'Total length------�_. -.J?____________________ �U Seepage Pit: Distance to nearest well----------------------Distance from foundation____-_.-•___--_----.Distance to nearest lot line---_------------ 171 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-----------------------------------------------------------------------------------------•------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------•------------------------------------------------------------------••---•------------------------------------------------•------------------------------------------------------- ------ ----------------- ------------------- ----------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------- 0 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. kt (Signed) .!-'f ------------------------------ By: ------------------------ ( lilbr Contractor) B -------------....................................................... ------------_ - o-; -----ar ---------- rifle (Plot plan, showing size of lot, location of system in relati to wells, buildinc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------- -- -------------------------------- DATE---------------------------------t --------- ----- ----- ------------------ REVIEWED BY --------------- DATE p .,.- # . BUILDING PERMIT ISSUED----------------------------- ---- - ' DATE --------f---- ------------------------------ Alterations and/or recommendations:-------- --------------------`----------------------------------•--------------...-------------------------------------------------------------------------_.. --------------------------------------------------------------------- -------------•----------------------------------------------.......................................----------------------------------------- ------------------------------------------------------ -------------------------------------------------------------------------------------------- -----•----------- --------------------------- ------ ---------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------- ---- -------- ----------•- -------------------------------- --------- --------------------------------------------........ ---------------------------------------- --------------------------- FINAL INSPECTION BY------------- --Z___ •-------- � 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 P.P.Co.