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APPLICATION FOR SANITATION PERMIT Permit No. .- /_ � ____ (Complete in Duplicate) Date Issued r�l .. 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- ----X� ---1�-& -- `''` ,14Q�------------------------------------------------------------ ------ Owner's Name ..... f -- - - ------- --- ------------------------------------------------------------------- Phone--------------------------- Address-----------------------f-46--10...-••. Contractor's Name------------------- Y.-.- ---------------------- --------------------------------.------------ Phone----------------------------------- Installation will serve: Residence P, ,70Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/___ Number of bedrooms _-;2!� Number of baths ___4 Lot size _xo��-- --f --LIP 0 Water Supply: Public system T--.C-ommunity system ❑ Private ❑ Depth to Water Table*." - ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No P!j0' New Construction: Yes ❑ No Pr FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: t Distance from nearest well-----------------Distance from foundation--------------------Material -----.---_---.-_.-----.------_----.------_-_-. ❑ No. of compartments--------------------------Size-----•--------------------------Liquid depth------- -----.Capacity------ ---------------- ?. Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_-_.___---- -... ❑ Number of lines-----------------------------------Length of each line-•-------------------------...Width of french----------------.--------.------_-- ( Type of filter material-------------------------Depth of filter material-----------------------Total length------._.-------.---------------- Seepage --------_-----Seepage Pit: Distance to nearest well--------- �-----Distance from fo ndation__ -_ .......... Distance to nearest lot line--.J-_--_----_ LOW* Size: Diamete'r__ _�s .Number of its----'../ Linin material--- aa�.� __-------De th-__,A47_/_- Cesspool: Distance from nearest well-----------------Distance from foundation-----.-._.----------Lining material--..----__-----_-.-----------_--- ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity-------------------------jgal, ' Privy: Distance from nearest well_________________---_-------.---------- ----.-Distance from nearest building_------_.------_-----__----.Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------Remodeling and/ r repair. - ----- ----------------------------------------------- - ------------------------------------------------------------IJ--------- I hereby certify that I have prepared this application and that the work will be done'in ac rdance with San , oaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------`------------•-- - --—- ---------- -- --- ------ ----------- ---------------- ---- ------{QIW r Contractor) By:---------'---------------------------------------------------- ----------- ----------------------(Title)--- (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- ------------- ---------------------------------------- DATE-------`�_ - W REVIEWEDBY-------------------------------- -------- --------------------------------------------------------------------------- DATE------------------------- ----. ------------------------- BUILDINGPERMIT ISSUED---------------------------------- -__----------------...------------------.---------------------- DATE-------------------- Alterations and/or recommendations---------------------- --- `------------------ -- = - --------C-------------------------------------------- t ---------- -------- ------------------pl-�-----J'------0 > ------ &--------FJ?Dm------- C1AY 7�� ---------r_R_ V---------- Iq FINAL INSPECTIO :. Date ------------------------ SAN JOAQUIN`LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet"- 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 0-'59 F.P.Co.