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l ✓ APPLICATION FOR SANITATION PERMIT Permit No. ._.1.-I5. (Complete in Duplicate) Date Issued This Permit Ex fres 1 Year From Date Issued 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. v ' JOB ADDRESS AND LOC TIO W -:---_-. 'o ------ Owner's Name----------- Phone Address-------•------ �---- Contractor's Name----------- �� Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _- Number of bedrooms _!a- Number of baths __/--_- Lot size ---_-_---------------------- Water Supply: Public system ❑ Community system ❑ Private Flovepfh to Water Table _4/o, . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er'lTardpan ❑ Previous Application Made: Yes ❑ No L?' New Construction: Yes 9 /No ❑ FHA/VA: Yes ❑ No 94-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic�Tank: Distanj e from nearest well_Ripe----Distance frQm foundation-_/e-------- Material-- ---.--------. No. of compartments-.-.X----------------size- --__ X -.---Liquid depth-----X_j > Capacity--- Disposa4 Field: Distance from nearest well/.-1109___-Distance from foundation---�e--------- Distance to nearest lot line--I?e----- Number of lines--_---- _--__- __-_ --------------Len th of each line---- -__ _- .--._-----.Width of trench___- A� Type of filter material_-/_j-A_ bepth of filter material-----If<i---_.Total length_------- ________________ �- Seepage Pit: Distance to nearest well.-12 ---------Distance fr foundation-- _-.---.Di a cAto nearest loft line- ��. Number of pits-------/-----------Lining rnafer`ial 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------------------- ----------------------- --•- ------------------ ----------------------------------------------------------------- Remodeling and/or #re ',r'ng (describe):----__ - --- ------------ __ _ -- __.------------------------------- - - --------- - - ---------------------------------------- ------------ ---- - - ----------------- -------- -r----- -------------------- .__._- - --_-_ _____.__---____--.-_-_-__-_----__---------_----_--_--__-__.-.--____-_-_-----_-.----_ _.--------..-----.--__ I hereby certify that I have prepared this applicat' n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru es and regulations of the San Joaquin Local Health District. (Signed)-------------- -- ---- - -- --------------- ------ -- --------{8v�'� r Contractor) ----------------- By:----------------- = -------------(Title)--- (Plot plan, showing size of lot, location of s in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--7_.nR-0-`------------------------------- -----------•----•----------------------- DATE----- ____(7 - --- ----------------- REVIEWEDBY--------------------------------------------- ---------- --------------------------------------------- --_----- DATE-------------- ------- - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations-----------------------------------------------------------------------•--•---------------------------•------------------------•------------------------------ ---------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ --------- -- ------- .--._-------.--. .-.. --- .._4-------._-_------------------------- ----------------------------------------------------------------------------------------- FINAL INSP ON C'f Date..... 1.: _ .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak.Streat 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California 5 Manteca, California Tracy, California ES-9 2M Re,� ed 9-'59 F.P.Co.