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APPLICATION FOR SANITATION PERMIT Permit No. ___� �.. . .. (Complete in Duplicate4 Date Issued V 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 in all theworkherein described. This application is made in compliance with,C_"buu�n-�ty.Ordinance No. 549. JOB ADDRESS AND LOCATION-------?/ Owner's Name-------------du0-1)-A9-------04xfv.?e _/ ------------------ ------------------------------------------ ------------------ Phone--------------------•--------------- P 7: Address-D—A ----- �- f4-14 - XI -------------- ---------------------------------•--------------------------------------------------------------------------•- ------ p Contractor's Name----------- lF-r�-�-f ----- 6------------ ----------------------------------------- ---------------- Phone-------- -------•-----_-----•---- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ d Number of living units: _f__- Number of bedrooms S_ Numberi of baths/_g Lot size ----------------- ---------- Water Supply: Public system ❑ Community system W 'rivate ❑ Depth to Water Table x_01' ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy earn ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Constructional Yes ENo ❑ FNA/VA: Yes J2-' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli____7�7=----Distance fromoundafion__ 4_V_______.Material___(P_.G� --------. No. of compartments... ----------------Size, _J�� ,?�-!!-�aLiquid d�th-----Iat-l---.---------Capacifiy�s�� ----- I___-Distance f n n__�_____----___ i tante to nearest lot line__0�_�__._ Disposal Field: Distance from nearest well,. ._ �p�� St1+o �� '------------------ RKRK Number of lines-----' - --�-----------Length of`e irle----_- - /- � 9vidth of trench-- -' ---- ---------------- (,v Type of filter material/"/ of filter material__.!�_____----_._Total length___-_ a ___________-.-____ .-COO s J r Seepage Pit: Distance to nearest well----------------------- from foundation__.fP_____.___.Dista�� to nearest�t line _-._ linin material`;1fPG ---Size:'•Diameter__, ..--------Depth--- ---------------------------- [�� Number of pits____-- g Cesspool: Distance from nearest weiL_______._------Distance from foundation____-..............Lining material------------------11,----------------__ El Size: Diameter-------------------------- -----------Depth-------------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from-nearest building-----_._____.________-__------__-_--.-. ❑ Distance to nearest lot line----------------------------------------------------------------------•�------ -•--------------------------------------------------------- Remodeling and/or repairing (describe)'-___V ---�-''��- - - - ---•---------------------_--------1_1------------------ -------------------------------------------- -----------------------------------------------•----------------------------------------------------------•---------------------- -------- -------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules a. d regulations of the San Joaquin Local Health District. (Qsq .ewaler Contractor] (Signed)_ ----------------------------- - ---- - - -------------- By:-------- ------------------------------------------- -- - -- ----- (Plot ---(Plot plan, showing size of lot, location ooiysfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMEN USE ONLY { APPLICATIONACCEPTED BY--------------------- - - - ------ -- ------ ------------------------------------- DATE-----------� 1�---G ------------------- REVIEWED BY--------------------------------------------------------- - --------------------- ------------------------------- DATE------------------------ -------------------•--------------- BUILDINGPERMIT ISSUED----------------------------------- -------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------------- --------------------------------------------------- -------•---•----------------------------------------------------------- ------- ---------- ---------- - ---- - - ---------------------------- ---- { ---------------- ------------------------------------------ -------------------------------------------------------------------------- - .----------------- ,ry ,i FINALINSPECTION BY- ------------------- ----------------------------------------- Date.--------_l ��. f�_f�-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak'Streat ° 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 P.P.Co.