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APPLICATION FOR SANITATION PERMIT Permit No. ..�,c_--9 _ ._._ (Complete in Duplicate) >e-) This Permit Expires 1 Year From Date Issued 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. JOBADDRESS A LO ION. - °_ -----------------------------------------------------------------------•-•-•----•-•-------------------------------- � 7 Owner's Name ---- ------- .. Phone------•-------------------------- - Address------------------------ �� tl ' Contractor's Name---- --------- -------- --- ----------------- ----------------- ----- =-_ ---------------- Installation will serve: Residence Apartment blouse ❑ Commercial ❑ ET�aile- Court ❑_.._Motels,❑. Other ❑ Number of living units: A---- Number of bedrooms _.- Number of baths ..I... Lot size ------------------------------ Water Supply: Public system 1�_<ommunity system ❑ Private ❑ Depth to Water Table,-5-off. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 211�ardpan ❑ Previous Application Made: Yes ❑ No �ew Construction-. Yes a <1 ❑ FHA/VA: Yes ❑ No jj�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / 1r Septic Tank: Distance-from nearest well______—______Distance from foundation_11...--------Material----- . --- -- -----------`±T .......,f No. of compartments-----2--------------Size--------- x Liquid depth_--.. ___._____________.Capacity. . -_. Disposal Field: Distance from nearest well-----------Distance from foundation.-:/0---........Distance to nearest lot line-7...... O Number of lines...._--._...2------------- - Length of each line-------- 4 ....---.-_--.Width of trench------±Z.f'__..-----..-.-._--._-. r Type of filter material....._" p •-- --..De th of filter material----- length-----�'1'�--------------------------- -� See a Pit: Distance to nearest well....��..---.-.Distance from foundation..:;ja..�_..._.Distan e to nearest lot lir�..._......�...._Eir 'J p Number of its---. -.-Linin material.�k.G_�---.-Size: Diameter._ X.�.._---Depth.._; ---------------------- p * 9 k Cesspool: Distance from nearest well-----------------Distance from foundation--- ---------------.Lining material-----------1------__.-.....__.---- (ZL ❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity---------------------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.-.----------- .-._-.-._-___.___.Q ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------- ---------------------------------------------- Remodeling ------------- ----- Remodeling;and/or repairing (describe) PJ---07—--- eLA_ (4- --- .'C:!--... _.. _ 14. aT—------TfI-E--------------------• , r fJ-�_------- S- `A -f T'l..t l�---------------�Mstp ----- - - 1I ---------------- -------------------------------------------------------•------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------- -----------•...---------------•-------------------------------------------------------------- ----------------------- --- 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-Healfh District. (Signed) --------------------- -- -- - ------Owner and/or:Contractor By:------------------------------------------------------------------------------------ --------------------------------------------(Title)------------------- ------- ---------- ----- -- -------------- (Plot plan, showing 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-------T1 R kO--+------------------------------------------------------------------- DATE-----5= D -- ------ REVIEWEDBY-------------------------------- ------------'•------------------------ ------------------------------------------------------ DATE----------------------------------------------------------- F BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------- ---------------------------------------------- Alterationsand/or recommendations:.-------------------------------------------------------------------••-----------------------------------••---•---•-•-------------------------•-•----------- ----- - •------------ -----------•--•---•-- �-------------------------------• •--••-------------•--------------••--•---•-------------------------------------•---------- ..�Q - --3------------ ------ •-----f'�f � 1 ------------------------------------•--------------------------------------•-------- -----------•------------------------- I ------------ -------- --------------- --------------------•----------------------------------------------------------------------- ------------------------------ ------------------------------------------------------- ------------ --------------------------- --------------- --------•---------------- ------------------------•-----------------------•----------------------- --------- -------- --- -------- , r FINAL INSPECTION BY:. r ' i Date-------- -3 -------------------- ------------------ 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 H-9-2M Revised 8-'59 F.P.Co.