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Permit No. __/,7-k 3- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued 059—tYfl(o2�, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he �esc17 ib d.G This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND ATION�I,RtT�:�1,-- r _: ------ r ,-_-Owners Name---- l-A . Phone,.),-- - _____________________________ ___________________________--------- Address----------- ________Address----------- •---- ----- V- .-. ...- Phone.. Sj _ _S Contractor's Name_- kl&-_44, - Installation will serve: Residence F1 Apartment House ElCommercial❑ Trailer Court Motel [j Other ❑ Number of living units: r!%94f _ Number of bedrooms --------- Number of baths ________ Lot size ------------- ----------•-•- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ - Clay ElAdobe fM Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No FMA/VA: Yes A❑ 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 well_________________Distance from foundation--------------------Material------------------------------------------------- O ❑ No. of compartments--------------------- ----Size--------------------------------Liquid depAk--------------------------Capacity----------------------- Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line___________..._ ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage � Seepage Pit: Distance to nearest well. _ �__�____-_Distance from f undation___________________.Distance nearest lot line__.__---_______-_ Number of pits-------- - Size: Diameter ------�-11--- Depth ___Lining mater idl..'> _ Cesspool: Distance from nearest well________ ______Distance from foundation_----._____.______-Lining material------------------------------------- ❑ Size: Diameter-------------------------- ------ -De th---------------- - -- --- --------------------Liquid Capacity-.-------------------------gals. R Privy: Distance from nearest well _________________________----------------------Distance from nearest building--------------------------------._______._. ❑ Distance to nearest lot line------ ---------- -------------- ------------- ---------------------------------•------------------------------------------------------ 0 in /or repairing describe): f ---------- -- tr1.''C.> a2�,.'-•---------------------------'�--------�----- ---- --------------------------------------------- --�.?� ------------------------------------------ --------------- ------•-------------------------------------- ------ - --------------------------- ------------------------------------------------------`-------------------------------------------------------- -------------------------------- 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 and regulations of the Seri Joaquin Local Health District. { r ---------------------------------------- --------- ` ,---- /or Contractor] `- --------- ------- (Signed)------------------ - ------------------------------------------(Title)------------------- ------------------------ ------------------ (Plot plan, showing size of lot, location of system in rela ion to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY ' .- APPLICATION ACCEPTED BY --------- DATE-- "_ _ O --- -- -- - _ _ REVIEWED BY `� '---- - -- DATE = -= BUILDINGPERMIT ISSUED--------------------------------------------------------------- ----------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:--------------------- -------------------------------•_---------------------- =�`' - I Of 71 X_�_ ------------------------------- ---------- • --- �': *"' --------- --------------------------- • ... 'r -e £ ` ------ .. --- ------------------- -------------------------------------------------------- FINAL INSPECTION BY:..Ie -� 4 ---- Date.__.3 ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' - `""-814"Tforth "C" Sfreet 130 South American Street 300 West Oal: Street 132 Sycamore Street µCalifornia Manteca, California Tracy, California Stockton, California Lodi, y r. ES-92M Revised 8-'54 P.P.Co. �,�