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,4 APPLICATION FOR SANITATION PERMIT Permit No. ._.� _�_1_____ (Complete in Duplicate) ��S - .— - - -- - - -Date Issued W Application is hereby made to the San Joaquin Local Heaifh 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----- y - ---------' -------- Owner's p Name---- -- --- --------- - - -- Phoned rJ=1,�`� c Address '�„� - --- --- - Contractor's Name------------ I-- ---------:------------ ------------------------------------ -------------- Phone----------------------- ------ r Installation Will serve: Residence., Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: '� :_ Number of bedrooms -ANumber of baths _/-__ Lot size _:_�" '�.: ___l_-`2__ _________ --------- Water Supply: Public system 'El Community system ❑ Private �pth to Water Table __fop ft- I Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] Clay ❑ Adobe Hardpan El Previous Application Made: Yes ❑ No Sand Construction: Yes [ No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic T ..n k: Distance from nearest well_________________Distance from foundation--------------------Material _______:=" ____________________::________- No. of compartments------------------1 Y ¢e Liquid�deiath ----------- ---------- - 1 1 Dispo I Fiel Distance`fromr4b6'rest we l____0_ .__ _ I i9 71,"'" � _ __ •istance from foundation ,� Distance to nearest lot 1+ of • ------- I , Number of lines__________ __�_ .. ----- -- _Length of each line___�'___�y�_ Width of french........ ._� ___ " d Type of filter mtena ____ -___�"f 'Depth of filter material_______�_Q_____ __Total length-------- __�i_ ______---- a rl �� ------- See e Pit: Distance to nearest yiell_1QQ___________Distanc fro 'foundation_______ _________Diita�cp� to nearest lot line_- _____-__ Number of pits-----------------------Lining material-_-- __ - -----------Siie: Diameter-------�--------.......Depth---------;?-------------------- Cesspool: Distance from nearest well----------- Distance from foundafion_7----------------Lining material---------------------------- I ❑ Size: Diameter--------------------------------------Depth--------------- ------I___------------------------Liquid Capacity----------------------- -gals. Privy;' Distance from nearest well______________________-i..__-____...___._____Distance:from nearest building-------------------------------- ,...7 [-] Distance to nearest lot line-------------------------------------------- ti-- " ` r Remo deling and/or repairing (describe):----------------------------------------------•----------- ----•------------------•---•------------------------------------------------ - fr ---------------------------------------------------------------------------------------..---------- "= I hereby certify that I havere ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Joa uin Local Health District. 9 y (Signed) f (Owner and/ Contractor) By:...... •� �.�'`�+ -----------------------(Title)--------------------------------------------- --- --- ----------- (Plot plan, showing size of lot, location of system in.relafi n to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --- -- ---- '; ---•----=-------------------------------------------------------- DATE�-----------------------_---------- ---- I REVIEWED BY ---- ' ------------------ ------ DATE -� == = - BUILDING PERMIT ISSUED------------ "' ------------------------------ DATE '� ------------------------ -- --- Alterations and/or reco mend ions:-------------------------- ---- ------ `'--------- " ---- ------------- -------...----•------------- i----------------------------- ------------- �T 1- ' � --�T- ---------------------- ------------------------------ --------------�- • --------- -- ----------------------------------------- -- y�. ' ------------------------------------------------------------41--------------- ---- FINFAL"INSPECTION BY':. �"' - ------------- Date. J 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 1-57 F.P.CO.