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� 1 � 0y _�� C� �/ APPLICATION FOR SANITATION PERMIT Permit No. .�.T�_----- (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued _�1-TlV __ _ .___ 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ ` ._: L_ ------ f G / • ---------------------- Owner's Name-------------= - --- ------------ - r - ------------------------------------------------------ Phone------------------------------------ - - --------- ---------- -------------------------------------------------•------r-�---�--------------------------- Contractor's Name------------------------------------------------------------ Phone,2Ft' - y�Peo Installation will serve: Residence M__Xpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __/- Number of bedrooms _ _ Number of baths --/- Lot size __. d_� -/_0-p______________ ________ ty system [IPrivate E] Depth to Water Tables ft. Water Supply: Public,system EF�_Communi Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2EI--Hardpan ❑ Previous Application Made: Yes ❑ No Eq—New Construction: Yes ❑ No [B- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I p1thin : Distance from nearest well-_____.___-.____Distance from foundation__________________-Material--__._.__------__.._______-_-----_--_...______- No."of com artments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- d: Distance from nearest well------------------Distance from foundation--------------------Disfence to nearest lot line-------------_-- Nu'm'ber-of lines---I------------------------•-----.-Length of each line--------------------------------Width of trench--------------:-------------------- 111 Type of filter material-------------------------Depth of filter material------------------ dotal length__-----_________-_-_________5-_-1___-- Seepage Pit: Distance to nearest weii Distanc®-f f vndation__IV-___ _-_.Distance to nearest lot line-� _---------- g...) Number of pi#s._._�/--------------Lining material--- 0 Size: Dia mete r---.�-?2---3____--Depth.... 5_------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-...-----------------Lining material__..____...._______-_-_-___-_-__.__.. ❑ Size: Diameter-----1 -----------------------------Depth-------------------------------------------------- Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------- ----.-Distance from nearest building--------------------------------------.-- [� ❑ Distance to nearest lot line------------------------------- -------------------------------•----- ---------------------- -----------------r------------------------ `• Remodelingand/or repairing (describe)------- ------- -----------------------------------------I--------------------- ------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ------------------------------------- --------------------•------------- -------------------------------------------------------------------------... ---------------------- ----------- . ---- ------------------------= ------------------------------------------------- ----------------•----------------------------------------------------------- I hereb that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances S to la s; and rules and, +reegulations of the San Joaquin Local Health District. (Signed)-----�a,_Vld--�- �'Y�--- - ----- ---- ----;-- -- --------------------- ----------------- By: ------------- {Owner and/or Contractor) gt ---------------- ---- -------- ------ ------------------ --------------------=--------- (Plot plan, showing size of lot, location of system in relation to w s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY----._-'r------------- --- - ---------------- DATE----------- DATE------ --- --- ------••---------------------- - -------------------------------------------- REVIEWEDBY------------ ------------------------------- . , - DATE BUILDINGPERMIT ISSUED............................... ------------------------------------------------------------------ ----------------------------------- Alterationsand,4or recommendations----------- ------------------ ------------------------------------------------------------------------------••--•------------------------------...------------ - -- ------ --------------- ---01 ------;*,I------------------------------------- ------------------------------11----------------------------------------------- : ---------- -------------••------------•-------------------•-------- ------- ------------ ----------------------------------------- --------------------------------- FINAL INSPECTION BY Date---- � ---- ---- - _0------------------------- -------- ---- - -- -- - SAN JOAQUIN LOCAL HEALTH DISTRIC 130 South American Street 300 West Oak Street rt 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. 1