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4 i� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made tole 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_ JOB ADDRESS AND LOCATION----- ,e-� -------• ---- ---------- ---------------- _ ..Owner's Name------- Address Or _ J --- - �i � Contractor's Name__. --------- --- =-- •_--••�fe-�� -----�- _�-1 ---------,�� c-__ Phon Installation will serve: Residence, Apartment House ❑ Commercials Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: I�______ Number of beEdrooms _ Number of baths -------- Lot size -'GGe- Water Supply: Public system ❑ Community system ❑ Private•❑ Depth to Water Table , ___ ft. r Character of soil to a depth of 2l feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ u TYPE OF INSTALLATION AND SPECIFICATIONS: Septi aokse tic tankst r cess of permitted if public sewer is available within 200 feet.) I P • p � � from nearest well- -Q6-_----Distance from JoVdation____ _ Material__;w1m-_Ar4 No. of compartments----------'-----------Size_'?_X-S-- --•---- q � Capacity ' Liquid de P.th___!,� _ Dispo,�aI Field: Distance from nearest well__-------Distance from foundation----/_0 ____:_.Distance to nearest lot line -.S------- Number ----- Type er fif;Tnes---••_-___f _-___Length of each line_______ r Width of trench___ yy- ll er material of filter material----- Type length____"'7 -_-'____*_"_-----_--`______ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-___-_---___- ❑ Number ofl�pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-----..--------.-----Lining -- Depth material_-__________________________________ eter-----------_------''---- - ----------- Li uid Capacity_ gels El .Size: Diam'I Priv Distance from � _____________Distance from nearest building om nearest well------------- -- ------------------------------------------ Dist ------------__-- i Distance t I nearest lot line--- Remodeling and/or repairing (describe):---z A----- ------------ei------�-� }�=-----------------------------------*�'` �= �i-� `" � - 11 `r ',f. � - - - - = -------------------------------------------------•-------------------------- --- -------------------- -= --------------- ---------1-----•---------------------•-------- ------------------------------------------- --------------------- ------------Ny ---I`-•- �------ r I here6 certify that I have re this application and that the work will be done in accordance with San Joaquin 6 Count Y Y � P P PP q Y ordinances, State law , and rules a re ulations of the San Joaquin Local Health District. Ik _ (Signed)------------- c �� f )Owner and/or Contrac+ar) Y•------------------------------------ --- -----------------=- ----- )Title)-- - .(Plot plan, showing size of lot, locationOT system in relation to wells, b ' ings, etc., can be pla ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , ` ---------------------------------------- DATE_.-----5__-.--_2.' ------------------------ ;REVIEWED BY---------- ----------------------------------------------------------- DATE------------------------- BUILDING PERMIT ISSUED-----!!-------------------------------------------------------•---------------------------------------- DATE------------------------------------------------- .Alterations and/or recommendations: = - = -------------------------------------------------------------------- ------------------------------------- ----------------------------------------------=-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- R ------------------ ---------------------------------•------------------------------------------------------------------------------------------•----••----•-----------------•------------------ ---------------------------- IM. --------------------------------------------------- - - - ---------- - ------- -- ----- ------------------------- - ------ ------------- -------- ------ •------------ -----------------------X� is --------------- ...... ----- -- ---.-- ----------------- FINAL INSPECTION BY:.--- �� = Date ��-- --- ----------------------------- V ----•-- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California f Lodi, California Manteca, California Tracy, California ES-9-2M Revised B-'59 F.P-Co. I it