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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued .___` _ (00 _-._t_�_✓- This Permit Expires 1 Year From Date-issued Application is hereby made to the San Joaquin Lova Health District for a perm`it.to construct and install the work herein described. This application is made in compliance with County Ordinanc �No. 549. 1y �o�.�n�t -----— --------------------------------------------------- Owner's --------- JOB ADDRESS AND LOCATION------- "`---'S'--��-rr,5`"....__� �'------------ -- --------------- ----------------------------- • . 11 -- �} ----------A"---------` -- ----- V, Phone. Owner's Name-----------------��------fs��*-�`�---� ��"•�-�------ --------- ----- - --••---- ----•-- Address-------------------------------1-f�------------------5--------------"-'�- _ -�, —•-'-�'�'�� - - ---- "r' = + Phone Contractor's Name-------------------------- --- ------------- 4 p h. N a, Installation will serve: Residence [ Apartment'1196, Commerc�al0 Traile'rtCourt .❑ Motel ❑ Other ❑ Number of living units: -------- Number of beclLms ____- Number of baths�___ItLot --------------------------------------------------•-------- � F k, Water Supply: Public system [�Community system�_'Private E] Depth to Wat,er Ti�b�le ___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe a Hardpan ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No A Previous Application Made: Yes ❑ N ®, �, . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest wel!_h.---", Distance from foundation_-____X'0----Material-______ _____ _ _ _ ______ ______________ No. of compartments------------ - Si - --- ,# ---Liquid depth..........•-i1�---------Capacity-------�}''--�-° Disposal Field: Distance from nearest well---- �._Dista:ce;fror�rp "oundation------1.G---.Distance to nearest lot line-----I____a_ Number of lines------I---------,� -- -- ngth of eac� line_---------:3-------f,-..Width of trench...._.------�------------ Type of filter material_ -- Depth of filter material-----_� ______dotal length_______________ ___________-- Pv Distance from foundation_ \ Seepage Pit: Distance to nearest wel4_____-_.___�'_ _ ________Distance to nearest lot line�__.�__�._. , Number of pits_-_-_-____/-------Lining material__.4ew—C A .--Size: Diameter__j347. /______.Depth_...Z_.-__________________ Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material___._ -----` . ❑ Size: Diameter---- ---------------------------------Depth-----------------------------------------:- ------Liquid Capacity----------------------------gals. 3 Privy: Distance from nearest well--------------------_----------------------------Distance from nearest building----------------------------_- ------- F1Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ - Remodeling and/or repairin [describe):___----__ _ x►C. -------------�;i _A ................ ------ x--- ' --------------- -------------- - �P t• g --:--------- ----- --- ------------------------------------------ ---------------------------------------------------------------------------------I------------------------------------------------ ---------------- ------------------------------------- ------------ ---------- --------------------------------------------------------•-------- ------------------------------------------------------------------------------------- ------------------------ - --- I hereby certify that I have prepared 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. �►� tiN1__ 4 (Signed)_--f -------------------------------------- ----------- ----(Owner and/or Contractor) -------------------•-------------------------. ----------- BY- (TItle --------------------------------------- ---- - --------------- (Plot plan, showing size of lot, location of sy9fem-in relation to_wells,buildings, etc., can be placed on reverse side). t FOR ARTMENT USE ONLY -------- ---@ APPLICATION ACCEPTED BY----- ------ = `- = DATE ------------------I-------- DATE ------------------------------------------------ REVIEWED BY----- -------------------- BUILDING PERMIT ISSUED----------------------------- ----------------------------- =--------------------------------------- DATE-------------------------- -- ---------------------------------- Alterations and/or recommendations: --- -- `."..,.W r�.-- - '---------------------------- ----•----------•- ---------------------------------------------------------------------------------------------------------------------------•---------------•--------•------------------------------•---------------- ---- ---------------------- --------------------------•-------- ------------ ------------------------ -------------------------------------------------------------•- --------------------------------------------I-------- - ------------------------------------------------ ------------------------------------ ---- - --- ------- --•------- FINAL INSPECTIO BY------- ----- =- - ------------------------- =: , ' Date--- :_' ----• ----------------------------�--- "SAN JOAQUIN LOCAL CAL HEALTH DISTRICT —✓ + � "e 130 South American Street 300 West Oak Street 132 Sycamore Street 914 No C Street Stockton, California Lodi, California Manteca, California Tracy, California 0 ES-9-2M Revised 6-'59 F.P.Co. • S�' �/