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APPLICATION FOR SANITATION PERMIT Permit No. ..... Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued .---3 _I _f Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the ork herein described. This application is made in compliance with County Ordinance No-1549. J08 ADDRESS ANDI LOCATI �- g' a'r ` Owners Name_ ------------ - - ----- .4. � ._ ---- ----- ----- -.-- Phone..:-.. ---------- ---------------------------- . ----------- ------ ------------------------------------ Contractor's Name--------------- - - ----- ---------- Phone---- ir...._. aw,- +..r.x -y----'----•-------- -- Installation will serve: Residence p _ © A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_-�_ Number of bedrooms _ -- -_- Number of baths --1-- Lot size -------er- Water Supply: ------------------- ppy: APublic system ❑-.�-Community system Private ❑ Depth to Water Table III Character of soit. l to a depth of 3 feet: Sand A Gravel ❑ Sandy Loam ❑ Cla Loam ' i y ❑ ,Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes' No A New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑, TYPE OF-INSTALLATION.;ANDISPECIFICATIONS:_ _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � - Septic Tank: Distance from i nearest well-- f__--Distance from foundation_--�0_ _ MaI terial---No. compartments of ---_---_ '"'• r i �---------- Size--- •-�--- Liquid depth------14------ --------Capacity--/, Disposal Field:' -- -"I" __Dis t -f p Qistance from nearest well- 11Z) from foundation- /Q__ tante to nearest lot line-- ( Number of lines-: - , 1 -------- --- ------ Length of each line �l�__-- .---.Width of french------- - Type of filter material-_--. sLe&Depth of filter material Total length_----_- i : 40------------------ Seepage Pit: { Distance to nearest well_ _-Distance from foundation------- -----------Distance to nearest lot line------_-----_---- p p - ^9 Depth --------------------- Cess Cesspool: Distance from nearest wall-;.:__-_. Distance from fo Number of its--------- -- - --- ---_Linin material__----___- ..__-_- _ . Size: Diameter_-.---._- undation._-----_-_ I I ;, Lining material ❑ Size: Diameter - - Depth----=-------------- 1 R. ----------------------------------- I -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.---- 'building-. n u 9 ----- -----------------------------Distance from nearest' Distance to nearest lot line-----------------/I--_-___---__ # t ------------ - *--=-G -a r lt_7 4_2 -------------------------------------------2 . ........ 66 - --- ----- ----- - ----- - - ---- - - -- - ----------- ----- --•--- ------ - - 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 jandd�rgull,ins of the San Joaquin Local Health District.(Signed } ----- -- - - - --7.7- -----------------------------{Owner and/or Contractor] . By:------------------------, e - _ -- -----------(Title)-------------- ------ ------------------- ----------------- (Piot plan, showing"Isize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-----.- ' ' F' =------- DATE REVIEWED BY----------------------------------------- --- - ------------------�------ DATE----------------- --•--------- ---------------------------------------------------- UILDING PERMIT ISSUED------------------------------ --- ___ __________________ - ------------------------------- ----------- DATE---------------------- Alterations and/or recommendations:.-'_._____-_----_-_--__ ------------------------------ i ------------------------------------------ ---------------------------------------------------------------•------------------------------------•-- ---------------------------- - --•------ -------------•----------------------------- --------------------- FINAL INSPECTION BY----------- ---- --- - Date_- --------------- -- --- -• .......-- -------------------- --------------------- 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 E5-9-2M Revises!8-'59 F.P.Co. I