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APPLICATION FOR SANITATION PERMIT Permit No. . . (Complete in Duplicate) This Permit Ex fres 1 Year From Date Issued Date Issued 11 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in iiompliance with County Ordinance o. 549,' s JOB ADDRESS AND LOC TION Owner's Name___ ___-�-- - _ --------------- -- ------------•---------------------- ----------------------------..-.._Phone---- ----------- '� ' Contractor's Name____ -'- _ _______ _______ _ _____.__4. �f� _____________________________________________ _________________________________ Phone.___.__.___..__._»_______..._____• Installation will serve: Residence /Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :----- Number of bedrooms`.3- I��I -- Number of baths ____/ Lot size Wafer Supply: Public system [1'__ommunity system ❑ Private ❑ Depth to Water Table-$_�&+f. ` Character of soil to a depth'of 3 feet: Sand ❑ Gravel [-] any ❑ Cla Sandy Loam Cla i Y Loam ❑_ l_y_❑ �}- _ Adobe Hardpan (] Previous Application Made: Yes ❑ No 93-� Iew Construction: Yes pg-'ro 0 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__ r / _Distance from foundafion_Al_-----------Material_____/..__._--___ No. of c8mpartments_...�_ _-.____---_-_Size------ x --Liquid depth___- ---"'. Capaeety_ _�_- --- Disposal Field: Distance from nearest welL/�ypy Distance from foundation__A>-----------Distance to nearest lot line_!;�-_-�_____. 91 Number of lines----------3_---- ___ _-Length of each line___.[S ------------------ +� ---------- - Width of trench.- ---:� Type of filter material___ Depth of filter material__ l i / -- -Total length- __&-D. , Seepage Pit: Distance Ilo nearest well_ -. f ' � ___.__Distance from foundation__ 8_-_-•___.Distance to nearest lot line-__ Number of --------------Lining materia._: _ .Size: Diameter. 'c- --- ----Depth------ �� Cesspool: Distance `rorn nearest well-________________Distance from foundation-------------------- material-.__._._..--------------------------- I -._..______._- ._ ❑ Size: Diameter - - -------- ------ Depth-, Li uid Ca acit ------------gals. gyp. q p Y- ----------- - -, Privy: Distance Brom nearest well------------------ ---------------------- ---Distance from nearest buiHin 9 ❑ Distance to nearest lot line----------------------------- ----------------------------------•-----•- -------------- Remodeling and/or repairing (describe)------------------------------ -------------------- y r -------------------•------ ------------------------------------ -------------------------------------------------- - '-------•-------------------------------------------•------ ---------------------- --•-------------------- �I IIII -- --•-----•--------------------------------•----------------------------------------------------------------------------------------------------------------------- ------ 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,W egulations of the San Joaquin Local Heal+h District. (Signed)----------- ------ ----------------------- ------------------------------------------------------------------ (Owner and/or Contractor) By:------ Trtle (Plot plan, showing size of lot,,location of system in relation to wells, buildings, etc., can.—be.—placed on reverse side). r - FOR DEPARTMENT USE ONLY . L APPLICATION ACCEPTED 1311r,... � - DATE Z r 1 ------------------- REVIEWED BY-------- rII BUILDING PERMIT ISSUED----'Ili ;_ " ----------------------- DATE -------------- :_4 - - -------------------- •----_ - A$EI,tions: 1Alterations and/or recommenda5 � k .__ _ ------ ------------------- l - " � - -----'Ii---------------------- -------------------------- - - I - ---------- ----- ---------------------------------------- ------- ------------•-- --------------- ------------------ ---------------------------- ----- ------------------------------------ FINAL INSPECTION BY: .---- ------ -------- ------------ Date--- 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 E5-9-2M Revised 6-'59 F.P.Co.