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rIJ_tc ---------- --- 4 Edd !/ - _ __ _z_1 c._L_ --- APPLICATION FOR SANITATION PERMIT Permit No. 5L...E .7` ' - ------------------------- ------------------------- (Complete in Duplicate) S ' -'"'--- This permit Expires 1 Year From Date Issued 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 LOCATION..__-------------------- __ :� - _ ----• -----------------------------------------------•-------•--•--.'--i•i•-..•------..........----._...... Owner's Name__ Address 1�� Q �. n r ti. r t Contractor's Name._._ .Q1 `' ca.�r` `"c-r Installation will serve: Residence ❑---A'- artm�ent House Commercial Trailer Court 0 Motel Other Number of living units: _j____ Number of bedrooms A____ Number of baths ...I... Lot size __�__� ......... Water Supply: Public system ©-116—ommunity system ❑ Private ❑ Depth to Water Table ...... ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loarn ❑ Clay Loam El Clay ❑ Adobe m Hardpan ❑ Previous Application Made: (If yes,date----------------/-) No New Construction: Yes 1+ No ❑ FHA/VA: Yes ❑ No Er---k TYPE OF INSTALLATION AND SPECIFICATIONS: V% I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1, Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material:______-___---_-________---__--_______----------- ��, No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity..................... !Distance from foundation_... � asp sal Field: Distance from nearest well _-___ 1_� _____Distance to nearest lot li��_�....._.. I �Y�aw Number of lines------------------ r ---------------Length of each line________j_22..........Width of trench__-_ _______________________ _ Tte of filter material__ �� tffilter ' Total length.........4; __�.___�,------- Seepage ____.- y See a e Pit Distance to nearestwel�_ _ ____Dsancaf from foundation 10---------- to nearest lot� e__ ❑ � l ?7 Number of Pits....../--------------Lining materialSize: Diameter___A _ ____----•Depth__ . �` I 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__________---___________-------_.________- l ❑ Distance to nearest, lot line--------------------------------------------- ........... Remodeling and/or repairing describe :________ __ _____ ______ --------------------v' --• --------------------------•----.............- ----------------•--•------------ --------------------••-•----------------••------------•----------•---•--- ...... ----------------- --------------------------•----•---------••-------•----___-----•-------------------------------•---------------••--------------------------------•------------•---------•-- -••---...-----------•-••-----------•-••----. ! ---•---------------------•-••----------------------------------------------------------------••--------•--••--•---•--------------•-•--------------------------------------________:..-------••----------•------------- t I hereby certify that I have prepbrLed 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. [ 9 }-----•----- ---- -------••----- - - ----------------------- ' - - [Owner and/or Cantractorl $y� = `".- ' J 1 a (rile) ems= �� = (Plat plan, showing size of t, location,of system in relation to wells, buildings, etc., can be placed on reverse siX FOR DEARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- --------- --------------------------- DATE---- �`--------------- REVIEWED BY.................................... t ---------- ---•-------------------- DATE--------••--•----- .. - = = BUILDING PERMIT ISSUED_________________4 — `` '— -- ` ------ — -------------- DATE--------- Alterations and/or recommendations:. ------------ __- . --------- ---- t/ .._ .... ------------------------______............_-------------------_ ----------- ------------------------------------------------------------------------------------ ...___-_________-..._______-_--_________-_ • 1 _____________________________________---------------------- _------------- _----------- _--------------------------------- ,._____-__-_-_____--_____-________-----____________-_____-___-_-____-----____-__---_______.____- ____________________________________________,-.--------___--________ -----____-----________--____-_-_____----.-------------------,___-_---_____--_______-____-___,---_--_________-______-_-__________----______----_-_______• FINAL INSPECTION BY:----C./--__----- �"' - � --- ----- Date. -- .9 [� SAN JOApUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 RM 5-61 AtLA9