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APPLICATION FOR SANITATION PERMIT Permit No. -__ l_( 9-b..... (Complete in Duplicate) Date Issued _11.341��-. 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. 11 JOB ADDRESS ANDL C`TION--------- - -- -- - - -- ----- Owner's Name----- ---.-- -- ----•-------- •---------------------------------------------- Phone- ` ,/�,, t -----••--------•----•-------••-------•-----•- -= Address--------------a�'°z� 9r rr..f�'-�°__------------------------------------------------- Contractor's_Name d ' e. -------------------- - , �� one �P. ik Installation will serve: Residence X Apartment Rouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other g s: -----I-- Number of bedrooms __- "- Number of baths ___!___ Lot size -� k AA Number of liven unit Water Supply: Public system ElCommunity system ElPrivate [4 Depth to Water Table " ft. Character of soil to a deptf« of 3 feet: Sand E] Gravel F1Sandy Loam [& Clay Loam [I Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION IAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) m Septic Tank: Distance from nearest well---- from foundation------.�Q___.___.Mater�al__ No. of'compartments___._-- - -- }q P. P Y � Z------ - ._ Size-- - �- -�-�--5-- -----�-Li Liquid depth Disposal Field: Distance from nearest well---.V-#!__._Distance from foundation____�_lp'---------Distance to nearest lot line___ -f"_-__.. Number of lines------�------------------------Length of each line_ jS1-± --°i`- -------Width of trench--- -��----.-----------------•-•- '-----------Total length---1-911--'-----------------------•-- Type of filter material.j�"9-"---Depth of filter matenal__�_`�'_ Seepage Pit: Distance to nearest well_______________-_----Distance from foundation--------------------Distance to nearest lot ine__.__________ _.- -Size: Diameter-------------- Depth------ ------------ ❑ Number of pits----------------------Lining material-------------------"-- ----- - Cesspool: Distance from nearest weil-----------------Distance from foundation.---_.___.___--__.Lining material---------- _------ gals, 7 ❑ Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid Capacity----------------------------g -_.____..._----Distance from nearest building----------------------------------------- Privy: Distance from nearest well ❑ Distance to nearest lot line--------- -------------------------------------•------------------------------------------------------------------------------------------ Remodeling and/or repairing [describe)-- -------- --------------------------- -----••----....------•------------•--------• •------- •- ------------------------------------------------------- l ---------------------------------------- ----------------------------------- -------------------•------------- ------------------------ ----------------------------- ------- ------------------------------------ -----------------------••"----------------------------- !p- -------------------•------"----------------------------------------------------------•--------------------------------------------------------------- I hereby certify thati1 have prepared this application and that the work will be done in accordance with San Joaquin County m ordinances, State laws, arid rules and regulations of the San Joaquin Local Health District. ---"----------------"--____-_.___.(Owner and/or Contractor) (Signed)--- !�- Plot Ian, showing size of----------------•------- ------------i ---- ----on-- -----ell ----------- s - c Title ( p g lot, location of system in rely+ion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---------------- ------------------------------------------ DATE_____-/3 ----------------------------------- REVIEWED BY------------------�-----• ----------- -------------------------- --------------------------- ---------------•------------ D ATE--------------------------------------•-------------------- BUILDING PERMIT ISSUED.-------------------------------------------------------------------------------- - ----------- DATE------------------------------ ----------------------------- Alterations and/or recomlm endations:--------------------------------------------- -------I-----------------------------I1-------- -------•----------------------------------- ----------------------------- ------------------------ -------•------- -----------•---------- ----------------------------------------------------- ----- ----•----------•------------ ------------------- ----------------------------------------------- -------------------------........ 11 -------------------- / I1Date__ .pf ! FINAL INSPECTION BY:.. ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street E32 Sycamore Street 814 North "C" Street Stockton, California'� Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Ca. II