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APPLICATION FOR SANITATION PERMIT Permit No. (CQrnplefe in Duplicate) Date Issued This Permit Expires 1 Year from Date Issued 2-�'-�-!tf�D--C3 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. r, JOB ADDRESS AND LOCATIO --- F ------- `' . l2'Q'� ------------------a �. :- � s`----��...------- Owner's Name--------------- 07 .........C CJ! Phone Address C 7 �Contractor's Name--------------------------------X511 _ -� -- -------------- • •---_. Phone....-----......................... Installation will serve: Residence [Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: _e_--- Number of bedrooms '- Number of baths -_/__ Lot size _____-- _, -._______________________.-...____-..--____ Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table /Irt. Character of soil to a depth of 3 fee+: Sand Gravel-❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ � -TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if,public sewer is available within 200 feet. r �, Septic Tank: Distance from nearest weH_ o stance rom`f upfiiation--- �._ eriai____._C.r-f��`--—._ __ N f No. of compartments_.______2--___-_ _�_._.__5ize_f—-. 3 --7______Liquid depth__._�________________Capacity...__��__----- � r - 1 Disposal Field: Distance from nearest well___.____ fstance from foundation.-/ to nearest lot line____ Length of each line___ _ .5_.°________________Width of trench____�_?�_.._____-___---.-_-_ 91 Number of lines________ __ g Type of filter material__ E Depth of filter material-___.l�_..--__-Total length___----/ __ ---------------- Seepage _______.____Seepage Pit: Distance to nearest well-----_----------------Distance from foundation....................Distance to nearest lot line------_____.__..- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--------._______.__.___________.- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------- ------------------------- °ga Privy: Distance from nearest well_________________________________________..._._Distance from nearest building-_-._..____________________________.._. ❑ Distance to nearest lot line--------------------------------- --------- ------------------------------ -------------------------------------------------------'--- Remodelingand/or repairing (describe)-----------------------------_- --------------------------------------•--------•----------------------------------,•----------------------------------- X .-- -------_ ------------------------- ------------------------------------------------------------------------- -------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- Q ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that 1 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 � r -�--4— *-------- ------------------------------------------------------- (Owner and/or Contractor) : :., sy.._... [Title) - -------------------------------------- ---•------------------------------------------------------------ (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). O 'D P KMENT SSE ONLY APPLICATION ACCEPTED BY---- -- • ---------------•-----------•----------- DATE---- f �� --------------------- ---- -- -- ---- - REVIEWEDBY--------------------------------- --------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------- ------------------------------------------------------------------------------- DATE--------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------•------------------------------•--------------------•---------- -•---------------------•--------------------------------------------------•-------------------------------•--•----------------------•-------•--------•--•••------•---•---------------•---------------------------------- �. --------------- -- ------------------------------------••---------------------------------------•---------- ...I---------------- --------------•-••-------.. --- ------------•-------------------------------------- --------------------------------------------- ------- -------------------- -------- ------------ ------------- ------ -------------------------------------------------- ------------------------------ --------------------- . l FINAL INSPECTION BY:.------- ---� ------- ------- -- ------------- Date_ !_- &-t--------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814.Norfh "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised 8-'59 F.P.Cc. _ I