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10 �1 �y APPLICATION FOR SANITATION PERMIT Permit No. .... ................ Q r' (Complete in Duplicate) ` Date Issued --- This Permit Expires l 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. JOB ADDRESS AND LOCATION------- t,,`_._----(e?v,�,7 ------•--- ---------•- Owner's Name--------- ------- rip"wo_.,./ ------------------------------------------------------------------------ Phone---.-..--------- -------•-------•--- Address---------------- ---• .. --------- ------------------------------------------------------------------------------------------- ----------------------........ Contractor's Name- -1r �' E'�-3 *� R�� : QCs Phoned Installation will serve: Residence Apartment House ElCommercial ❑ Trailer Court E] Motel E] Other El Number of living units: --- __ Number of bedrooms --7-- Number of baths --1__ Lot size _;__ p��__: _-._ ��------------- ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -f,U ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan L] Previous Application Made. Yes ❑ Nof New Construction: Yes E], NoX .FHA/VA-. Yes ❑ No 2r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I pts Distance from nearest well_________________Distance from foundation________.-_-_-_____.Material--------_.___._._-_________.____--- _____. No. of compartments------- ------------------Size--------•-----------------------Liquid depth--------------- ----------Capacity----------------------- Dispo Distance from nearest well------------------Distance from foundation.-------------------Distance to nearest lot line----------------- Number of {ines-----------------------------------Length of each line-------------------------------Width of french--------------:-------------------- g, Type of filter material-------_____-------------Depth of filter material-._.:._________-------Total length--_.____________-__________-------------- r �. e Distance to nearest well___ ance f om'foundation-----/ ---------Distanfp to nearest lot line---- ------ Number of pits____ _____________Lining material Size: Diameter__.---_------Depth__.. esspool: Distance from nearest well----------------- from foundation---a._..________-Lining material____..._______- ❑ Size: Diameter--------------------- ----------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-__------_.__________.____.._------ ❑ Distance to nearest lot line--------- ----------------------------------------------------------------•---------------------------------------------••------------------- Remodel' d/or, ring (describes---------- ---------- r } ----------------` ------------------------- *al, ------•----•----------- r I - -------- = ----------- % ✓ ------- ------------ - - - ------------- ------------- I here�cerfifyve prepared this application that he wor w' be done in accordance with San Joaquin County ordinances, State laws, and rules and re latio s of an aquin Local Health District. Si ned • . (Owner and/or Contractors 9 ----------------- --- By: - ' By:----------------------------------------------€-------------------------- -- r (Title) (Plot plan, showing size of lot, location of system i relation to wells, buildings, et ., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------ ---------------------------------------------------------- DATE — ��' ----------------- REVIEWEDBY----------------------------------•------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------•-------------------------•----------------••---------------------------•------------ DATE-------------------------------- -------------------------- Alterationsand/or recommendations:------------------ ------- ------------------------------------------------------------------------•--•--------------•--------•------------------------------- ----------------------------------- - - ---------- - ------ ---------- . ---------•--•-----------------------------------•--- -1�----'`��--- . _. '-�.._ __ .. = : ---� ---- ---- ---------------------- --------—--------------- --------------------------------- ---------- ------- --------• ------------------------------------------ -•----- ------------ ----------------------------- ----------- - --------------------TION BY------ ------ ------- - --•----------------• ------------------- - --- -- ---- --- I -------------- Date----- ---- ---------------- ----•-------------- FINAL INSPECTION �• �JOAQUIN SAN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. — f