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/A4�?-"//j PLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) J 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 Ordyiaan e No. 549. JOB ADDRESS AND OCA .ION...... - Owner's Name---- - ---`P-, ------ ` '- --------------------------------- Phone. _ - ! Address --2Q-/ -- •Ct / f Contractor's Name------ - r ---- - ------ -- -- ------- ' _-. Phone __ .::21 f` Installation will serve: Residence Apart ent House ❑ Commercial ❑ Trailer Court ❑ Motel Cher ❑ / ' Number of living units: _/_ Number of bedrooms�Z- Number of baths ----- Lot size .,�,,��-�--/----_-__-.._ � 4 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 0"Ir Hardpan ❑ Previous Application Made: Yes ❑ N6"g New Construction: YesX No ❑ FHA/VA: Yes ❑ NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation--------------------Material----------------------.---------....._.__-._.-. No. of compartments-------------- ----- -----Size-------------------------------Liquid depth--------------------- - --Capacity----------------------- Disposal field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____-_..._...._. Number of lines-----------------------------------Length of each line------------------------------Width of french-----------------•-------__-------- W Type of filter material-------------------------Depth of filter material----------------------- otal length_-.-..-____...._--............__0------- O Seepa e Pit: Distance to nearest well. f. ...___-._Distance from fo dation_��_ (-'___Distance to nearest lot line'__ z�_ ZI Number of pits---- -----------_..Lining material ..Size: Diameter-___._4�d----.-__Depth-_..�Q .. ....... Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F-1 ----------- p --------------------Liquid Capacity--------------------------•-ga" Size: Diameter--------------------- -----De Depth ---- - - -- - - Privy: Distance from nearest well-_.._____..__-----------------------_---------Distance from nearest building_-........-------..---__.-_-.----..------ ❑ Distance to nearest lot line---------------------------------- ------------------ -----------------------------------------------------------------•-------------------- : Remo g and/or r p n clescribo]:.. �= ------------ �- _ ------•------------•--•----•-- ------------------------------------------------- ------------- ----- --- ------------ - ---------------------•-------••----- ----------------- --------------------------------------------------------------------------------------•---------------------------------------------------------------------------------- -------r------------------ I hereby certify that I have prepared this applicatio and t f the work will be done in accordance with San Joaquin County ordinances, State la. nd rulexqa reguiatio of f an uin Local Health Disfricf. (Si ned g ) =" '� l- (Owner and/or Contractor) By:-----------•- -- - ---- -----------------------------------------(Tifle 7 '--T --------- ------------- (Plot plan, sh f , loc y of system in relation to wells,, buildings, etc., can be pl ced on rever side). ' t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED .BY.--------- Q ------- ------------------- DATE I•` 2 3 > - -------------------- REVIEWED ------------------- REVIEWEDBY------------------- ----------------------- --------------------------------------------------------------------------._._.. DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------- ----------------- DATE------------------------------------------------- Alterationsand/or recommendations----------------------- --------------------------------------------------------------------------••----------------------------._---------------------------- ..-..- •---------- --- -- --- -- ------------------------------------------------------------ 1 ------------------------ ------------------------------------------------------------------------------------------------------------- 77 �. ------------------ - ----- -- -------• ----------- FINAL INSPEC ` ��- - r - -7---- f --- •- - - - - -� Date--..-. -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreot $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.