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APPLICATION FOR SANITATION PERMIT Permit No. .....................�. (Complete in Duplicate) Date Issued ... This Permit Expires 1 Year From Date Issued 1 r Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. !r JOB ADDRESS AND LOCATION' ----- 2W__!ejW1§_.0 . ......•--STOCK ONS CALIF.-------- ---------- ` -------------- ----------------- Phone:40__�'°'153?----------•-- I' Owner's Name-------------------------- t GRA,VES Address------------------------------------ ------ ------- --------------------------------------------- --------------------- 1TSFi'. }5 ----------•------ ------------- ------ Phone-- � Contractor's Name--------------- __...-----•------------------•---------------• - Installation will serve: lResidence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _3-___ Number of baths ---I_ Lot size -----------�--1--4Q-------------------------------- Water Supply: Public system ®' Community system ❑ Private ❑ Depth to Water Table $0--- ft. Character of soil to a depth of 3 fee+: Sand E] Gravel ❑ Sandy Loam ElClay Loam [IClay. E] Adobe M Hardpan F] �* Previous Application Made: Yes ❑ No FE] New Construction:' Yes ❑ No FC] FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance frorn nearest well-N-me_____Distance from foundation----2Q__ft...Material-------------------------------------------- __:. No. of comparents--------------------------Size----------------------------_---Liquid depth- Capacity tm ` Disposal Field: Distance from nearest well-----------------Distance from foundation------__------------Distance to nearest lot line____-________---- 1 Number of lines-----------------------------------Length of each line-------------------------- Width of trench------------------------------------- type ----- --- ---.----------- ------ Type of filter material-------------------------Depth of filter . terial----------------------Total length-----------------:----------------- ----- Seep gewPit: Distance to nearest wall_Tijpe----------DisfanCe-from foun .ation___.2p_._ �. Distance to nearest lot line__-��___----- Number of pits._..j---------------Lining mater -----ROM---- .-Size: Diameter------33�_-In,---.Depth------2.}--Ft-------------- Cesspool: Distance from nearest well-----------------Distance rom foundation___________________ Lining material------------------------_________-_. De th----------------- ------------------------=----------Liquid Capacity- - ------------------------gals. Size: Diameter-------------------------------------- p Privy❑: Distance from nearest well---------------------------------- -----------Distance from nearest building----------------------------------------- - ❑ Distance to nearest lot line----- ------------------------------------------------------------ -- ------------------------------- Remodeling and/or repairing (describe):----------------------------- --------------------------------- - ------------------------------------------------------- l ---•-----------••-----•-------------------------------•-------------------------------- -------------------------------------------------------------------------------------------------------------- -------—----- y PP 1 hereb certif that I have re ared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sa�, Joaquin LocalHealthDistrict. - .eTi-----------------------------------------(Owner and/or Contractor) (Signe4_4d) - -------=-- ---- ------- -------------- - ------ ---------------- -------------------------- (Title) - ------ ----------- E (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 APPLICATION ACCEPTED BY-- - - --- ------ DATE -7 v REVIEWEDBY------------------ -------- DATE--------------------------------------------------------- - BUILDINGPERMIT ISSUED------------------ --------- ---------------- DATE-----------=--------------- -----------------------------:... Alterations and/or recommendations---------------------------------- --- -------------------- - J/-- R. --- ------------------------------------------------------ - -- A = __: �Y ��-�`---'�---- -- - --------- -1--�-- -r - --�--� -7__ ---�`_k"__- ___� --------------------- ----- --- --- --- 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 i, S ES-9 2M Revised 8-'59 FTP Co. - _ inn.'-��•