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-4t_ APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Date-Issued This Permit Expires 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 compliant with Co Ordinance No. 549. DsI - If-3sD Ill JOB ADDRESS AND 10JCATI ------ f. .�r,Q �o--o`, Owner's Name------- - ---------------------------------------------------- ----- -------------------------------------------- Phone---------------------------------•-- Contractor's Name - --- ---- ----------------------------------- Phone_ Fs /D `S_ Installation will serve: Residence ❑ .,Apartment House ❑ Commercial Trailer Court ❑. Motel,❑--Other[1 Number of living units: _vol._ Number of bedrooms _e-__ Number of baths ________ Lot size _ _ -------- Wafer -_.-Water Supply: Public system ❑ Community system ❑ Private,i Depth to Water Table Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:4 Yes [] . No OT FHA/VA: Yes❑ -No Q-. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P S , Septic lank: Distance from newest weli_____7____/._-Dis#ancje from foundation_____ _/____0_________Material_____ . ----------------- No �r . of compartments______t- _ ________ --__Size_,�X_S`+�__X_ ,_Liquid depth___ ....... �1 6 Disposal Field: Distance from nearest well, ..vr�._:_._Distance-fr6m foundation-----Id-----____Distance to nearest lot lin Number of lines______:___;_----------A--------Length of each line------------------------------Width of trench____ ---------- Type of filter material___ _ - ..f f YP Depth of filter materiaL___.__1_g_ _____Tota! length �____,_}- ©-------- f s` Seepage Pit: Distance to nearest well____.__/QO_____Distance from undation______ _�____._.Distance to nearest lot line_________________ ' 0 Number of its______._ _.Size: Diameter__.______ p �__-_-___Lining material----------- - ----- ��...._.Depth- ---aV-s Cesspool: Distance from nearest well-----------------Distance from foundation----_---------------Lining material-------------------_---_____________. ❑ Size: Diameter------ -------------------------- --Depth-----------------------------------------------------Liquid Capacity----------------------------gals. _N1 Privy: Distance from nearest well------------------------------------------------Distance from nearest building__________._____________________.__.__. ❑ Distance to nearest y lotline--�---------------�-----j--�-------------------------•------------------------------------------ -------- n ibe):-----&I - - - p dRemodeling 9des& ---------------------------------------•---------------•--------------------------------------- -----------•----------------------- •------------------------------------------ ------------------------------------- -------------------------------------------------------•----------------------•---------- I ' ---------------------------- ----- ---------------------------------------------------------------------------------------------- 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.San Joaquin Local Health District. (Signed ' - `'�/ a -------------------I'E^es--atmVm.Contractor) . By:------------ -------------------------------------- ----------------------- se.----------- (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be placed-on reverse side). POR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y_._ __ _ ,, ,,s.Gt. v DATE ' -- ------------------------------------------------ REVIEWEDBY--------------------------------------------- -----------------------------------------------------------------------------• DATE--- BUILDINGPERMIT ISSUED------••--•------------------------------------------------------------------------------------------ DATE--------------------------------------------- -- Alterationsand/or recommendations:----------------------- ---------- - ----------------------------------------------------------—A-------------------------------------------------------- --- -- ------------------------------------------ ------------------------------------ -----------------•.----- - - ----- ---- -------------------------- -41 � ------_-_ --------- ----------------•- --- ---------------------------------------------------------- J f------------------------------------------ --- --- ---- FINAL INSPECTION BY: ------------------------ SAN ------------------------ _._ 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-92Ph Revised 6-'59 F.P.Co.