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S -�r APPLICATION FOR SANITATION PERMIT Permit No. ..................- (Complete in Duplicate) Date Issued t1tJsGLv,� .t This Permit Expires 1 Year From 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 w County Ordinance No. 549. f Q !/ C Y ��-4 JOB ADDRESS AN LOCPtT ON r7 � •-- ---- -- --------------- Owner's Name l ^�C .' ---"--'--`"•------------• ----------------------------------- - ---- Phone Address----------- �•. 'L.L-�'L.��------ ----------------=`"---�----------------------------------------------------------- -- -------- -----;------------------•--• •----------------------------•-•--•-------------------•--------------- Contractor's Name__. --- ------------------------ -- Phone Installation will serve: Residence 14 Apartment House ❑ Commercial 0. Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ---1__ Number of bedrooms- Number of baths ----1-_ Lot size ._- _ ------ - .` --------------------------------- Water _______________________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 IN Hardpan El Previous Application Made: Yes [] No FNL New Construction: Yes ❑ No [�Lr FAA7VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f ; (No septic tank or cesspool permitted if public sewer is available withint-200 f6et.) Septic Tank: Distance.from nearest weVl-----------------Distance from foundation___I---------------Materia3_-__.__________.---_-_.__-_________-.-------___. ❑ No. of compart4ents------------ -------------Size--------------------------------Liquid depth----------- ---- ---------Capacity------- i r i Disposal Field: Distance from nearest well- --._Distance from foundation. _-AE j- -------- Distance to nearest lot line___ ------ Number of lines-----______{{__�__ Length of each line---------- �j_______-Width of trench__-t---7_____?r___________________ IF Type of filter materia l.__, •-Depth of filter material___fT-_______--Total length------f _____-____-_____-____. page i Distance to nearest well---- _____ Distancef undationi____/Q./.___.Distar9ce to nearest lot 're_ ____--- Number of pits-------/------------Lining material--,� '__--Size: Diameter----`'i F------------- Depth------- -----------------------. Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material_________________________________--- a ❑ Size: Diameter--------------------------------------Depth-----'------------------------------------ --------Liquid Capacity----------------------------gals Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---------------------------------------- 1* ❑ Distance to nearest lot line.- - -------------------------------------------------------------------------------------------------------------- Remodelin dor re pairing ----- '__- --�---4 -±" -`—----~-�-•------------- 9 / p 9 } ---------- - --- ---------------------'------- - -------------------------------------------- - ,VL �. __ '�'- ----e- 14 i -----------------------------------------------=-------------------- ' _ a -- _ I hereby certify that I have prepared this application and that the wrorlc will'be done in"accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ----_-Owner and/or Contractor (Signed)--`- ---` ( / ) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------- --------- ......----- (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 APPLICATION ACCEPTED BY------------- ---- --- - - ----- DATE----------- , r REVIEWEDBY------------------------------------- ------- ---- -- -------------------------------------------- DATE--------- '- ---- ---------------------------- BUILDINGPERMIT ISSUED--------------------------------- ------------------------------------------------ ---------------- DATE--------------------------------------------- --------------- ---- y ---------- Alterations and/or recommend tions:----- --- ------------ -------------- -------------------------------------------------------------------- ------------------- --- ---------------------------------------------------------------------- FINAL INSPECTION /BY:---------------------------------------------------------------- Date--------------------- ------------------------ - ------------------------------ 2_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 2M Revised 6-'59 FY.Co,