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zY7' �4 :.� APPLICATION FOR SANITATION PERMIT Permit No. _jl.Al f_..... (Complete in Duplicate) v This Permit Expires 1 Year From Date Issued 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. R_ a JOB ADDRESS AND CATION__ / '------------•---------------------- ----------�---i --------------------D f .a Owners Name---•-------- ----_ --- - - - --- ----- ------ �-------_—r-rrvne-----•---•---------------- Address --------------? -------------------------------- •-•-------------------------- ..-------------------------••---•--- -.---------------. ------••---- Contractor's Name-------- �ri� �- 4[{ ------------- Phone.._.--•---------------------------- Installation will'serve: iREsidence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ - Number cf living units: _ 7-7 Number of bedr oms ,__ Number of baths J__- Lot size/Q-0 y _ _Q,� ____________-___ .01 Water Supply: Public%system .Community system E] Private I–] Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑w Clay Loam ❑ Clay ❑ –Adobe�ardpan ❑ Previous Application Made:Yes E] No New Construction: Yes El No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S pt' Tank:' Distance from nearest well`__.-.__-_-_.__Distance from foundation--------------------Material ___._____._---...-..____-_--______.__s-.________. No. of compartments _ Size Liquid depth C apacify --------- D4Zp al'Field: 'I Distance from nearest,.weil-----------------Distance from foundation.-,eZO-_�_.__.Distance to nearest lot line---- [ � ',Number of lines___:___ _______ __________Length of each line----_R _ -----_._____--.Width of trench_---.020 '' ---------- Type �4------- g � -&V_�___-Distance to nearest lot lin ' Type of filter materia€_� � - :Depth of"fil}er material___ g Total length J_.�._'_______,-________- Seepage Pit: Distance to .nearest ell_____________---------Distance fr foundation e__' -�_• VJ ❑i Number of pits..... -----------Lining material___ _W'_Size: Diameter-__!11li–e--------Depth-.-- _� _---------- Cesspool: iDistance from nearest well-----------------Distance from foundation------------------- material---------------------------__.---___ ❑ Size: Diameter Depth -- --- ----------------------- ----- -------- --Liquid Capacity-----------------------'.gals. m , Privy: Distance from nearest well---------------- ------------------------------Distance fromg nearest building -___________________-.__. ` ❑., . . .'.Disance'to nearest lot line =" ------------------------ --------------------------------------------- Remodeling and/or,repairing (describe :_________________�___1 ------------ -------- '- -------_.- __ - _______-_ -------- I -- -- ------------------------' _____________ _ _ -. -___ w _________________________ _________._ ..___--__..__.___._-.._._________________________-_________________._____________--_-_-_-___ _.__._ _.__________._..___....___..____._---__-._ I hereby certify that I have prepared this application and +ha+ +he work will b d nein accordance wifh San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a f ---- ' ------------------------------ ------------------------------------------------------------------------(`mor Contractorl By:------------- ----- - - ------------------------------------------------------------------------------------(riifle)------�?_ZiW_..---- ---------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).- _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- , ---------------- DATE---- REVIEWED BY --------------------------- DATE = BUILDING PERMIT ISSUED.---------------------------------- '" w ------------------- ------------------`--- --------- DATE----------------------- -- Alterations and/or recommendations------------------ {--------------•----------- r f.-..._--__ -__..._ ______________ k ___.___-_-__ ___ ------------------- ----�.:T-----_-9rTT-d------ �-------DtA--------ay, � -------------�- - 3--r-_-a-------------------G ------------------------ -------------------- -------------------------------------------------- -------------------------------------------- --------------------. . --------------------- --- '. --- ----------------------------- FINAL INSPECTI BY:- - --------------- - ----- Date--- I- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak SN*st 132 Syeamore Street 814 North "C" Street Stockton, California Lodi, California Manteca',"Califcrnia Tracy, California ¢' ES-9—$M Revised 8-'59 F,P,Co.