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. �- APPLICATION FOR SANITATION PERMIT Permit No. / (Complete in Duplicate) �___ � This Permit Expires 1 Year From Date Issued Date Issued .___� __ -yd___ 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 rdinance No. 549. JOB ADDRESS AND LO ATIO -------- ---------------lf-------------- - - -- - -- ----------- ---------------- Owner's Name______ - ---- -------------- Address------------------------2164-91- Contractor's _13- A- Contractor's Name _------------------------------- Phone----------------------------------- Installation will serve: Residence *-Ixpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms __ ._ Number of baths __�____ Lot size X—Y--_Y-1__�a_ ,� ---------------------------------- Water Supply: Public system Wi,ommunity system ❑ Private ❑ Depth to Water Table 4'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe EF'lardpan ❑ Previous Application Made: Yes ❑ No &---New Construction: Yes EA`11-o ❑ 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: Distance from nearest well_________Distance fLQm foundation_/�___r__._-____-Mater'l__.. w .----.--. No. of compartments--------------------------size----------_____�S`,�_')_Liquicl depth------Jy----------------Capacity--__r Disposal Field: Distance from nearest well---.:""-------Distance from foundation....,«_0-____-Distance to nearest lot ling_ Number of lines___.______--_ � ________.Width of french----------v�_ AV aL--, �G.+v______________Length of each line__-_._-_� _ Type of filter material---- Q_1~__ ..___Depth of filter material___1__ y_._______Total length-----------I0— ___________________ .� Seeps Pit: Distance to nearest well __._' ----------Distance from foundafion___1.10...._ stance to nearest lot l�inye__ 119 Number of-pits.____---.----Lining material____ _.Size: Diameter._. _a(.C______-Depth__________ _________________ Cesspool: Distance from nearest well_________________Distance-from foundation___----------------.Lining material_________._____.__.______-_--_.-..._ ❑ Size: Diameter--------------------------------------Depth------------------- --------------------------------Liquid Capacity----------------------------gals. rn Privy: Distance from nearest well---------- --------------------------------------Distance from nearest building.___________________.__________.___.__. ❑ Distance to nearest lot line----------------------•------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----------P--i-.0r------_ 717P------ ---DAWN----- Rt�T�---�'1--r�------------ v - , -------------------------------------- IkKa. ------------ ----------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , d rules nd regulations of the San Joaquin Local Health District. (Signed)---------- --------- -------------------------------------------------------------------------------------------------------------------•----(Owner and/or Contractor) BY:-----------------------------------•----------------------------------------- ------------------------,----------------------------(Title)--- ----------------------------------------- -- -------------- - (Piot 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__.__ _P4• --.__..._._ -------------------------------------------------------------- DATE------��--'-�z'�--'--��--------- - - REVIEWEDBY----------------------------=------'------------------------------------------------------------------------------------------ DATE---------------------------------------- BUILDING PERMIT ISSUED-------=-------------------------------------------------------------------- ----------------------- DATE Alterationsand/or recommendations---------------- -------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------- ------ -- -- -- ----- ------ �1 � `a..� -----�- C-x ------ --------------------------------------------------------- --------------------------------------------------------------------------------- ---------------------------------------------------------------- FINAL INSPECTION BY...----- -f.-`--'---. Date--------.7--------- SAN ` _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 E3-9-2M Revised $-'59 F.P.Co.