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l APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ..q� This Permit Expires 1 Year From Date Issued ---��. .1--- 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 withCountyOrdinance No. 549. JOB ADDRESS AND LOCATION ------/4_0 -----------------------f------------------------------------------•---------- ---------------- Owner's Name-------------�_ -------------------- --------------:---------- Phone'1� �= 7 // Address---------�•/--f------- •-- . ------ ------------------------------ --------------------------------------------------------r---------•---•------- Contractor's Name_ Ton l r Installation will serve: Residence [Apartment House ❑ Commercial ❑ CE]Trailer ourt Motel ❑ Other ❑ Number of living units: __9--__ Number of bedrooms -Number of baths __/-- Lot size --�5 - 1- -------•- Water Supply: Public-system 'M Community system ❑ Private ❑ Depth to Water Table -------- ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sancly loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No TK New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ' arrl' Distance from nearest well________________Distance from foundation----.---------------Material-----------------------------.--__.-.._________- --Li Liquid de th--------------------------Ca Capacity --- No. of compartments------------ ----------Size---------------•-------------- q p. P Y-------------- ---- Disposal Fielder Distance from nearest ell(?�p _Distance from foundation.._._Lr�__------Distance to nearest lot line__..-- Number of Ii.—------------------------------------Length of each line__ ') -------,---3 C'--- - Width of trench.... ` ---------.- �� i<.t---__Depth of filter material-------- length__-._-_-._.��_--3c�r.-- T e of filter niaterial� - ---'----- �. • D- to ce to nearest lot line___:- Seepage Pit: Distance to nearest well-- '�_.__-_D�stan�e from foundation _ ;'.________. _Li ing m #erial.et�4- Size: Diameter._ ______________Depth_-�r _--- j� of pits ------ ------------ Number � i Cesspool: ° Distance from nearest well _ ante o found ------------- ❑ Size: Diameter. - ep ----� -------------- Liquid CapacitY ------------------------gals, --- Privy: Distance from nearest well----- __ ------Distance from nearest building__--____ .._____._.-. El Distance to nearest-]of line----------------------------------- - = Remodeling and/or repairing (describe)------------------ -------------------------------------------- ----------------------------------- ---------_------•- ------------------------------------------------------------------------------------------ - - --- --- --- - - = -------- ------ ----- 1 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 ulations of the San Joaquin Local Health District. - - -(Owner and/or Contractor) (Signed)_ ---- -------- --------------------�--------------- By:----------------••-----------r--------------------------------------------------------- --------------------- (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 DATE-------- --- --- --- APPLICATION ACCEPTED BY--------------- � c REVIEWEDBY-------------------------- - ------------------------------- -------------- DATE------ --------------------- BUILDINGPERMIT ISSUED-=...`-------------------- ----- DATE-------:------------------------------------Y---•----------- Alterati ns an /or recomme54atior ------ -------------- - ------------------- - C �'- .. - - 2 D - _ - -- - -- ------------ x ---------------- ---------------------------------- -----• ---------------- -------------- •--------------------- -------- FINAL INSPECTI Dated-- -~ �----- -------- -------------------------- - • `SANy 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 ES-92M Revised 8.'59 r.R.eo.