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APPLICATION FOR SANITATION PERMIT Permit No. ....� � (Complete in Duplicate) Data Issued l __l..G_,l_. F 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. JOB ADDRESS AND-LOCATI �_�--L_og _r4 '. Owner's Name---------Ee.... ---------------------------• ---- ----------------•--- Phone------------------------------------ Address.---------------------------------------------__J<4'_O - --------------------------------------------------------------------------------- Y— Contractor's Name----• � �.aAJ-C-�--------- -------•---------------------------------------------------------------- -- Phone -•-- Installation:will serve: I Residence El- Apartment,House ® Comm0cial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: --- Number of bedrooms __IS- Number of�baths ---k--- Lot size .--------___-------=---------------------------------_---_ Water Supply: Public:system ElCommunity;system-0 Private,V1 D�p+filjto Water Table _ ft.(A-PPR0)0 I Characte 161 soil to a depth oft3 feet: Sand El I Gravel ® Sandy Loam N Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: YesEli No N w CBnstr ction:i Ye 4N 6, ElFHA/VA: Yes ElNo ❑- TYPE OF_INSTALLATION AND SPECIFICATIONS. a (No#septic tank or cesspool permitted if public sewer is available within 200 feet.) "y i i Septic Tank: Distance from nearest--welL_t�O--_-�.Di tante from„foundation--_.1-0_-_---.-.Material------�O.-rt1 --------------------------- No. of compartments----------� ---------- -Si �X�� Liquid depth . Capacity $OQ-- c'-ALS. Disposal Field: Distance from-.nearest,.well---1-�jr-Q'jDistanco;from foundation-----1-6----.!! Distance to,nearest lot line----------------- aw. -------------{Len Length' of�each line-SF x_3 _ ? x30Width of trench-_.-A4-” � Number of lines---------�.-- 9� )- -- - --------------- Type of filter material----RWk,-JI?6,Pt'h of filte��,Material------j- ]- .......Total length------1- ----------------- ----- Seepage Pit: Distance to nearest well----------------------Di'sstance�from foundation-------------------.Distance to nearest lot line-_l4"------- ❑ Number of pits-------------------- Lining �--------Size- Diameter-- --------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Qistancefrom foundation-------------------.Lining material----------- ------------------- ---- ❑ Size: Diameter------ -------------------- ----------Depth_--------=�-----:!---- ------ Liquid Capacity-._ gals 'Y 4 I Privy: Distance from nearest well----------------------------- -------�-.-1Distance from nearest building------------- ❑ Distance to nearest lot line----------------------------------------- ------------ - ------------- -- ----OLA-'---------------------------•--------------------- - --------------------- ---- 1 » Remodeling and/or repairing (describe):----- -----•4A-------------------------------------------------- ---•------------------------------------ ----------------------------------------- ---------------------------------------- ---------- -------•------------------------------ -----------------------------------------------------•--------------------.------- -•------- -------------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules an.c&re (A tions oith an Joa um Local HYalth Dis+rict. [Signed)----: �-�.- '- -- - ---• --------- { er and/or Contractor) --Own "' ..1-,i1 -3- 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 I `' _ ---------- DATE APPLICATIONACCEPTED BY-- �-��---- -° --- ----- - -------------------------------------- �"`---- -�---- -- ------------------------ REVIEWED BY DATE----------------- i----------------•----------------------- ------------ BUILDING PERMIT ISSUED-------------------------------------------------------- DATE Alterations and/or recommendations:------------------- ---------------------------------------------- • ----------------------•----------- I ----------------------------------------------------------------------------------------- ----•----------------------------------------------- -------------- - -------------------------------------------------•------- -•-------- f ------------------------- ---- ----------------------------------------- ------- --------- --------------------------------- - ----------------- 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 Revised 8-'59 F.P.Co.