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f 0 APPLICATION FOR SANITATION PERMIT Permit No. ..�1 t (Complete in Duplicate) r� This Permit Expires 1 Year From Date Issued ----Date Issued ._f � f ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f This.applicatiori,is-.made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATI( ----------- Owner's ----------Owner's Name--- -_---------•-___--- --- ----•---------------- - ------------------------------------------- -----------------------------------------. - Phone Address------- -- •---•----------- . - ---------------•----------•----•-------------------------•-------•------------------------- ontractor's Name_ Installation will serve: Residence k Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -� Number of bedrooms __------ Number of baths _o*-__ Lot size __,1-0-'t-_L-17- '-------------------------I------- Wafer Supply: Public system ❑ Community s Pp y' tY stem y ❑ Private ® Depth to Water Table ,30-__ ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ff) Clay Loam ❑ Clay ❑ Adobe[1 Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ® No ❑ FHA�Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) / N ; Septic Tank: Distance from nearest we11_ O"---__--Distance from pfoundation--/a_!--__ Material_ ---------------- Disposal ---------- No. of compartments---- ------------------"--Size__ --------Material-. depth-_�----- -. -- - - - -----Capacity-/_.� Disposal Field: Distance from near,Ist well.��_'- --Distance from foundation__AP -----_ yl Distance to neared t line__'---_---- (,Q ! Number of lines_a-, f_1-�}v-F 1- bLength of each line----- Width of trench-- __.- ----------------------- Type of filter materia- -' ------------ Depth of filter material- - _.-.__"_Total length-_�-_--,,,' ----- Seepage Pit: Distance to nearest well----------------------Distance.from foundation------------------__Distance to nearest lot line---- 171 Number of Pits------------------------Lining material-------.-----------.---Size: Diameter------------- D ________.._ �. - ---------- p -------------------------- esspool: Distance from nearest well '___-__.'__Distance from foundation-------------------- material_"____.________: __________._- ------ EJ Size: Diameter, Depth Liquid Capacity gals. Priv 1 E Y: Distance from nearest well-_.,'-----------------------------------------------Distance from nearest building J e *-.. 9 -------- ❑ Distance to nearest lot line------___ _____-___ - -------------------------•--------------------------------- - ------------------------------------------------------ Remodeling and/or repairing (describe):---------------------------- \ w ---•----------------- t v.. -----•------------- -------------------- 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. (Signed)---- - r .. i--------------------- ----- --- --- ----- ----- ---------- --------- ----------- ---------------•---- - -----(Owner and/or Contractor) BY:-------------------- ------------------------- =----------------- - - - ----- Tifle (Piot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "- -- - _ - -- ----------------- DATE¢"tl - REVIEWED BY - ------ ----- - --- - DATE------- --------------------- - - - - - -- ------------------------------------------------ UILDING PERMIT 155UED---------------------------- ------------------------------------------------------------------------ DATE---------------------------- -- -Alterations and/or recommendations:__:"__-_-______________________ ------------------------------------- ------- --------- ------------------------ FINAL INSPECTION BY:. - ---------- Date__. -- `_--___ ----- r ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Streeti 814 North "C" Street Stockton, California F Led% California Manteca, California Tracy, California E5-9-2M Revised 8.'59 F.P.Co. 7