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APPLICATION FOR SANITATION PERMIT Permit No. ._ .1., _ 7 ___GA (Complete in Duplicate) ` This Permit Expires S Year From Date Issued Date Issued ------- Application pplication is hereby made to the San Joaquin Local Health District for a permit to cons c install the work herein described. This application is made in compliance with County Ordinance No. S49. -7_(�1.4n1-- xC`r/+.cfElL-S'.4-C_�4-✓-�t ;x /3" �,��,/ JOB ADDRESS AND LkOC TION. - `----- --D 2��o�Q� '� r - =/�7 ' Owner's Name--- ---------------- ---------- ----- -------------------------------------- Phone------------------------------------ Address---------------A°Y' s 'A'Sl l r --------- ------------------------------------------------------I---------------•--------------------------------------- Contractor's Name +pT `------------------------------------------------------------•-- -------------------------------------------- Phone------------------------•---------- i Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other y❑ Number of living units: --f---- Number of bedrooms .s3__ Number of baths An._ Lot size�,OJO_'-1--•¢------l0-± Z l Water Supply: Public system ❑ Community system ❑ PrivateA Depth to Water Tableb_ ft. Character of soil to a depth of 3 feet: ; Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: YesA No ❑ FHA/VA: Yes ❑ No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wail-ad- -b- ----Distany from fo ation---1a-------Merial----- ------------------ - eLiquid depth of compartments_.-_� ---___ Capacity__ ------------- Disposal _____Disposal Field: Distance from nearest well.�d'. Distance from foundation_j _P_________ Distance to-nearest lot�line---�11..------ C3 Number of lines___`-`f"- f Length of each lili�'__ _a ��--.Width of trench_...�.-�,_____________________ } Type of filter materia / ----Depth of filter material-_---J_g_�__.____Total length__---0-Q__________________________ `1 Seepage Pit: Distance to nearest wel ______________________Distance from foundation______...__._._____.Distance to nearest lot line__._---__---___._ E] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- ' Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------_____.._____.______.________- ❑ Size: Diameter----------------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------------------------.____--- ❑ Distance to nearest lot line--------------------------------------------- ------------------•--------------------------------------------------------------------------- Remodelingand/or repairing {describe):--------- ---------------------------- ---------------------------------------••----------------•----------------------------------------------------- i --------------------------------------------------------------------------------------------------------------------------•-------------------••--•------------------------------------------------------- ------------ t ------------------------ ----------------------------------- ---------------------------------,------------------------------------------------------------------------------------------------------------------ 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. 01f (Signed)------- ---- ----------------------------- ------------------------------------- -----------------------------(Owner and/or Contractor) 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--b/7 _41-------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------r---------------------------------------------------- BUILDINGPERMIT ISSUED----------- I-----------------------------------------------•--------------------------------------._ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- I. -------------------------•---------------------- { ---------------- ----------------------------------•-------------------- ----------------------------------------------------------- ------------------------------------------------------- -------------- - --------------------------------------------------------------------- •------------------------------------------------------------------------- ------------------------------ ------------------------------- - FINAL -INSPECTION BY:.------r ----------- Date h. ------ --------------------- SAN 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-9-2M Revised 8-'59 F.P.Co.