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APPLICATION FOR SANITATION PERMIT Permit No. 2��_ ....... (Complete in Duplicate) �!� This Permit Expires 'I Year From Date Issued Date Issued _______1----_f_____. 2r2� Application is hereby made;to the San.Joaquin Local Healfh District for a permit to construct and install the work' herei� �n°dtes cribed. This application is made in compliance with County Ordinance No. 549. d7t1�"< , JOB ADDRESS AND LOCATI N.. g -----'--G r d - -- AA --- u_-` e -�------------------- Owner's Name �_f_`t__ --- ----------------------------------r=t ----- Phone---.--------------------------•---- ----------------------------------------------------------- Address---------------------------- ` "_. ------ .----- Contractor'sk Name Phone..--------•----------------- ----------------------- ------ Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___f__ Number of bedrooms __10) dumber of baths ___/__ Lot size --- __. !__A----Q--_____________________ Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table __ _ ft. Character of soil to a depthof 3 fest: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelsrf Hardpan ❑ Previous Application Made:',Yes ❑ Na New Construction: Yes �No E] ❑FHA/VA: Yes No � TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance' from nearest well-JO---0__Distance from foundation___ �I J0------ _Matgrial----� No. of compartments ---41 .64__ _Liquid de th_ Capacity-----Disposal Field: Distance from nearest:01. ell_ 8 _ Distance from foundation- Z6- -_-.Distance to nearest lot lin _---/0-_____ � v° Number,of lines_________ _______ ___ Length of each line _40 T_ .Width of trench------. __.-----------______ a Type of;filter material_-__�_T epth of filter material_______ s _ __Total length-------11 ___ _________________ Seepage Pit: Distance to nearest well -----------Distance from foundation___-----------------Distance to nearest lot line------ Number;11rof 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--------------------- ---------------------------------------------- r w _ , I hereby certify that IAave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an"d/rules and regulations,of the San Joaquin Local Health District. (Signed)-- -------i- ------ -------------------------------------- ------ -------------------------------------(Owner and/or Contractor) �e -------f --- -----------------------Title ---------- (Plot plan, showing size of lot, location of sysfem«in relation to wells,-6uildings, etc.; can be placed on reverse side). s .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED iBY `----------------------------------------•------------------------------- DATE--------------•--------- --------------------------------- REVIEWED BY----------------------•----------------s--..------ -------------- { ,..- `- :-- -------------------- DATE---.---- j ` y=r�� BUILDING PERMIT ISSUED- ,-------------------------� ---- __M%0 e� ---------------------------------- DATE--------------------------------------------- --------------- Alterations and/or recommendations:-_--__---_.___._."":_4_- `------" �" " -- -------- -------- ---------------------------------------------- ---------------- ------------------------------- -----'------------------------------------------- ------------------------------------------------------------------- IM ' ------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- --------------------------------------- -------------------- ----------- �. Z Date------------------- 1 JFINAL INSPECTION BY: __. I� SAN JOAQUIN LOCAs. HEALTH DISTRICT 130 South American Street. 300 West Oak Street 132 Sycamore Street 514 North "C" Street Stockton, California f Lodi, California Manteca, California Tracy, California - ES-9-2M Revised 8-'59 F.P.Ca.� } II