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r i --)v-CC/ / Permit No. __...� �' { � APPLICATION FOR SANITATION PERMIT � �------•-------- , (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 compliance with Count Ordinance No. 549. JOB ADDRESS A LOCATION... pp ----- � Owner's Name------- -'441-41-----------------------------------------------------•----------------------------------------- �!-------------------------------------------- - Address_. -.1C.` --- ----- .� � ------------•---------------------------------- Phone ........... --.®r�---------- , Contllation will serve- Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other - C,4- e � 4 Installation � PJ t Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size.----------------------------------------------------------- j Water Supply: Public system ElCommunity system❑ Private E4 Depth to Water Table — ft. Character of soil to a depth of 3 feet: Sand E]Gravel [jSandy Loam a Clay Loam [IClay E]Adobe '❑ Hardp66nn ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHANA: Yes ❑ No D ` TYPE OF INSTALLATION AND SPECIFIb'ATIONS: 3 (No septic tank or cesspool permitted Efpublic sewer is available within 200 feet.) `n Septic Tank: Distance from nearest well_�i ._x�--- ,Distance fFom foundatian�PPRix, 4?-.MatenaL____ .�-c_--_.-/--7- Q� P r ---:--_Liquid depth ------------------------ -Capacity.- No. a acit .- No. of compartments-------�-------- ------Sizer- P Y a" ---_Distance fo'nearest lot line________________ 1 Disposal Field: Distance from nearest welL>�7-- '._.Distance from,,onnciation_=._-- ` �f Number of lines_ -_-_______.d2 _ r9 '"""�Len'g%1� o each line_R(Q-''�---_t_rWidth of trench._ -------- _ . s. - 9T "l T e of filter -material__ O.'Me'l ---Depth of filtsrumaterial -I •_�-.rte Total"length__ ' - -- n-="`-^! Seepage Pit: Distance'to nearest,well:�_____.___--Dista.- nce:;from#foUndafiioR�_._____...... Distance to nearest lot line______ _______ __ ❑ Number of 'it -,,••r..�. Lining- at aal �_.�D]arr�eter Depth _ ; Cesspool: Distance from nearest well_______________ _Distance from {foundation -._________----.._..Lining material____--_-.-__________--.-_._____.___ !. ❑ Size: Diameter Deptb_._.. ; -----------Liquid Capacity gals. Privy: Distancejfrom nea e}st 'well___....------ �--#Dissttan�ceAL rom nelrest kiuilding__________________________________________ ❑ Distance tonearestlot I� i+~ ------ --------------------- descr'ibe}:--------------�-• --•------------•----------------------------------------------------- Remodeling and/or repairing - -----------------------------------------------------------------------•----------•----,-.--------------------------------- ------------------ - - - ---- ---- 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. (Owner and/or Contractor) ----------------------------------------------------- (Signed)--- - --- -- •- -- - ---- - - - - ------�- -�--- � -- (Plot plan, ing 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 €� - `' - BY --- DATE------------ ------------------------- -------------------- REVIEWED ------------------------------------------------------ - BIJILDING PERMIT ISSUED ------------------------------'' DATE _.. Alterations and/or recommendatios f 6 -------------- -I --------------------------------- -I -- ------------------------- --------------------)------- - --------- - -.-------- ------------------ ---- FINAL INSPECTION BY:._-- Date---- -------------------- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F, P.Co.fA .