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jf k APPLICATION FOR SANITATION PERMIT Permit No. .-l..�: S (Complete in Duplicate) _ _., Date Issued __________.-III---___-•• i ` ` This-Permit Expires 1 Year`From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construcfC-Finstall the work herein des ribed. Thispapp lication.is made in com lia,nce with County Ordinance No. 549. N ,rF f Cir"GJ�4 .'' . 1-30 - Y �'�--�---�--------------------- - JOB ADDRESS AND LOCATION _._'" ,---� _--- -- JOwner's Name----�/ ._ +��-_-- '---------- --- Phone... ?.. ------------------------------- Address-------- ..--=' -Phone ---- Contractor's Name------- - !l�9C": i,_ ._ i Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ 3 f Number of living units: .....__. Nuber }f bedrooms r baths _ o ----- ------------------------ r` md-- ft. Water Supply: • Public system El Community- ye; El Private ® Depth Water Table # r Character of soil to a depth of 3 feet: Sand [] Gravel ❑ _,Sandy-Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ 11 Previous Application Made: Yes ❑ No t4 New Construction: Yes, ] No ❑ FHA/VA: Yes ❑ No ❑ �. i TYPE OF-INSTALLATION AND SPECIFICATIONS: ' $� k (No septic tank or cesspool permitted if public sewer is available within 200-feet.) Septic Tank: Distance from nearest well--�-_0:0-_Distance from foundation__.- .+-_-Maafe-,iai- ! ------------=---------- q p. 7.. _ Capacity. --- - ---Size-. 2. '- ---Li Liquid de fih- - -^ ` No. of compar#ments___.y . �-- � •.-„. Disposal Field: Distance from nearest well_ - --_Distance from foundation_99 71--------Distance to nearest lot line...._ _-_-"..4 Number of lines------ -.-'--- ------ ------ Length of each line--j-&-:E----------------W,idth of trench....-, ^_ -`=------------- Type of filter material r___Depth of filter material _ --_---_°'-Tatal•-length_._ __! ?___.--- '`- -- r --- # ;., j. ' O o nearest we�_...-_- ._.___Distance from foundation-�-C.:�___----Distance to nearest lot line-J.'+� ".,- W Seepage Pit: Distance t "� j` — Number of pits--- _------- Lining materia--seize: Diameter-_T- `__.------.Depth--- ' Cesspool: Distance from nearest well-----------------Distance from foundation___- ----------- Lining material.-j'---_.- ---------- ------- . - ` --- .. gals` ' ❑ Size: Diameter---------------------"----------------Depth---------------------------- ------------- -------------------------- Li uid Capac�fYf = ___..Distance from nearest.bui4din f�r - ----- Privy: Distance from nearest well-------------------------------------- I ❑ ------ Distance to nearest lot line.___-"..............__".._ ----------------- Remodeling and/or repairing (descritae):--------- ------------------------ -------------------- ----------------•------•--------------••- ------------- _ _ �Q k --------- ------ ------- ------------------ ----------------------------- ------------------ ------------------------------------------ ---------- -- ------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. _`t v r � •- Owner...and/or Contractor) ------ . ( (5sBY� I j '�'L4t','' ---------------------- --(Title)---------`------------------arse side). f .. [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,`can be placed on re e FOR DEPARTMENT USE ONLY = I APPLICATION ACCEPTED BY_..._ ,, --DATE---- �� '°1--"---------------`------- REVIEWEDBY------------------------------------- --- -------- --------------------------- --------------------------- BUILDING PERMIT ISSUED---•------•---------------------------------------------- - DAT -------------------- and/or recommendat'ons:.. -------- ------------ --------------' ` -- - t '' e •1-M----------------------------------------- ------------------------------ - ----------------- ----------- ------------- .......... ------'---------- 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 ES-9-2M Revised B.'59 F.P.Co.