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♦. I APPLICATION FOR SANITATION PERMIT Permit No. ... (Complete in Duplicate) / Date Issued This Permit Expires 1 Year From 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. 3 05- 's a . 0jz© f ------_--- ------------------- JOB ADDRESS AND LOCATION--------------------------------------------------------------- -5STQC_ TQ Owner's Name------------------------- rk ------------ --------- ------------------------------------ Phone-- Address-------------------_---------------- -5' t ----------------------------- ----------------------------------------•-- ........... Contractor's Name--------------------------- -------------------•------ .-•--------- ---- Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _- - Number of baths --------- Lot size -.._. ��-/ ,T / ---------------------- Water Supply: Public system ❑ Community system ❑ Private ❑, VDep th to~Water Table�S�ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe6, Hardpan ❑ Previous Application Made. Yes ❑ No% New Construction: Yes ❑ No 9 FHA/VA: Yes ❑ No o 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 from foundation------Al--------MateriaV-------C ,q ,—.v_t---------------- Liquid, depth_., ----------------------Capacity----------------------- i �� No. of compartments Size --------------- I Disposal All Distance from nearest well__.f�O�.._Distance from foundation___._.-__.__`Distance to nearest lot ine_____a_S __ Number of lines----------------/----------- Length of each line----------- _0/-------Width of french----------------------------------- Type of filter material__�e<_ _____Depth of filter material-___.__!�_� _---Total length__________ 4---_______..____,_-_.- Seepage Pit: Distance to nearest well____j..�C1_�-___Distance from f undation-_-._-7-,5-._____-_-Distance to nearest lot I'ne>.-_I ___.__ ' :Diameter._r _� _Depth------ ----------------- ------- Number of pits______.__,___- ---Lining Size matenal._.�-CC`. _ . Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material---------------------------__-__---. ❑ Size: Diameter-- Depth---------------- -- -----------Liquid Capacity- ---gals. ! Priv Distance from Distance to nearest lot list me--------------------------J, __---__-- ..Distante from nearest building_!-______._________._-_-___.._.---_-_--. ---------------------------•---- ©; f Remodeling and/or repairing (describe)------------------ ------------------------- ------------------------'.? a , ---------------------------------------------------------------------------•------------------------------------------•--------- _. - ------ - ---- --------------------•------•-------------------------------------------------------------------------------------------------------------------------------------------- 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. ✓� ge'' ' l %. �V�!/1/l�l> J /� - -------- --- ----------------- (Owner and/or Contractor) (Signed) - - - �. ------(Title)------------ ------------------------- - - -- ---------- (Plot plan, showing size of lot, locafion of system-in-relation fo wells, buildings, etc., can be placed on reverse side). F RD P MENT USE ONLY APPLICATfON ACCEPTED BY-. - ------- Y ---------------------- :DATE --------------------- - -- - REVIEWED B ------ DATE----------------------------------------------------------- --------- ---- ------------------------- ------------ ---------------------- BUILDING PERMIT ISSUED ---- ------ `DATE ---------------------- and/or recommendations: ---- - --- JQ ti --• - --------------------------------------------- Alterations . . r ---••------------ --------------------------------------------- -------------------- -------------- ----------------- r -- , - ---------------------------------- --------------------------- ------------- FINAL INSPECTION BY:- t � U '--- --------- Date----------.P.`------2- = CC1 ------ - i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street R' Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M • Re_sed 8-'59 r.P-Co.