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0 APPLICATION FOR SANITATION PERMIT Permit No. ..... j% (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to tlie`San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance withi�ou nt Ordinance No. 549. JOB ADDRESS AND LOCATION.-•-jV `..-� Owner's Name - [_/l �J G'1.. - - Phone.... ------ Address------------ ---...�?'- ---- ----- � - = - --- - ----- Contractor's Name------111 = ff�Y�+' *'"' Phone Installation will serve: Residence ® Apartment House ,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 Number of living units: /__ Number of bedrooms _ ___ Number of baths _,/___ Lot size _._-C..t-- -----------I------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam ❑ Clay Loam [❑ Clay ElAdobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ FHA/VA: Yes [J No TYPE OF INSTALLATION AND SPECIFICATIONS: zgn�L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL_�Distances from fo�dation_/47>ti"t"-Material___G__�_�`'��______________ No. of compartments__-_-_ ____Size_ ___X_3 __'J__ ____.Liquid depth_-- -__ ____�- --- Capacity____ �P_P,..___ Disposal Field: Distance from nearest well_-n�._.Distance from foundation _O__'r?"4. Distance to nearest lot line_•__ © Number of lines------- ___Length of each line_______ ___._.__-._ Width of trench____ __ __ ____________________ Type of filter material,__5,_ -Depth of filter materialIr ______-Total length--------- ___Q_________________________ Seep e Pit: Distance to nearest well__ -____Distance fr° ' f9undation______________.Distance fio nearest lot}ne__-- ----------- Number of pits.__.__C____________Lining material___-L ==1�- Size: Diameter___ 3___,__-____Depth_--------,______________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.------------.____.__--_.-.--- ____El Size: Diameter--------------------------------------Depth---------------------------•------------------------Liquid Capacity----------------------------gals. " Privy: Distance from nearest well--------------------------------------------- ----Distance from nearest building-.________.______________- ___._____- ❑ Distance to nearest lot line- - ------------------------------------------------------------------• ------------------------------------------------------ ---------- Remodeling and/or repairing (describe):--------- -------------------------------------------------------•-------------------------------------------------=--------------------------•-------- I --------------------------------------------------------------- ------------------------------- •I ------------------------------------------------------------------- q _______________ ------------- ------------------------_----------------_____________________________________________________________________________________________________________________________________________________________________________________ I 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. (Signed)-•- �?/ �/ -- ---- - --------------------------------------------------------------------(Owner and/or Contractor) I By---------------------_-------- ------------------ - Tale ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY 7 = DATE -7 - T.-- - ------------- REVIEWED BY---------------------------------------------- -------:--------------- DATE -------•------------------------------------------- ---------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE_------------------------------------------------------------- Alterati ns nd/or � recommendations: ions: ---------- - -- ------------- - v--------. .-•------------- -- 4-.- ----- -�------------- --------------- -------------------------------------------- ------------------------------------------------------------------------------------------------- ---- ----------- FINAL INSPECTION BY:. ---------- 7/ ------- ---------------------------- -------------------------------- Qate %i �J ��1--------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Ra�isecd 8-'59 F.P.Co. / -