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AlU� _ 1/ APPLICATION FOR SANITATION PERMIT Permit No. .1f.�1: .. ... t (Complete in Duplicate) l 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. JOB ADDRESS AND LOCATION.. r -S---7--- ._ L ----------------------------------------------------------------- Owner's Name--------- --- ----- ------------------------------------ Phone------------------------------------ I Address-------------------- � �� - ------- ---------•----------•-----•------------ Contractor's Name--------- --------------- - -• --- -•------ `=' == " - Phone, �G~ �"� ` --- ----- V1 ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ (Motel Other ❑ Number of living units: . Number of bedrooms -9-- Number of baths _�Lot size ..!/ - / ` Water Supply: Public system ❑ Community system ❑ Private E-IDepth to Water Table SD it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B- -Hardpan ❑ Previous Application Made: Yes ❑ No d�New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer er is available within 200 feet.) ' Septic T k: Distance from nearest well_Jr_Z----------Distance from founjation__,3P---------- Material ` __ _____________ [ No. of compartments---- ------------------5Liquid depth_-G1l1L _ -- -..-__-Capacity__�1�___ ze_ c _ __� Dis osaI R Id: Distance from nearest well-.4 Distance from foundationi_�X,0_________.Distance to nearest lot line____________ Number of lines________ _ Length of each line-_gQ_'____�d___....Width of trenc ------------------------ Type of filter material_S-r_ c---Depth of filter material----- "_______Total length------� —a___------------------ (n i Seepage t: Distance to nearest well_( r_.__-_Distance om f undation__.k4__''___.Dista!e to nearest lot lin�_s_-_____ 'Number of pits------ ______________Lining material__ �.__.Size: Diameter----3.3-----------Depth_._. _-___-------_----. Cesspool: Distance from nearest well________________Distance from foundation-------------------Lining material-_-__.-__-______-_---.--_--._____---. [❑ Size: Diameter----- ----------- -------------------Depth-------- ------------------------------------------Liquid Capacity----------------------------gals. Privy- Distance from nearest well _ __-__ _________________________________________Distance from nearest building ❑ Distance to nearest lot line - - -- ---------- ------------------------------------- ------------------------- ------------------------------------------ Remodeling and/or repairing (describe):---- ------------------------------------------------------------------------------------- -----------------------•------- ------------------------ --- ----------------------------------------------------•--------------------------------------------------------------------------------n-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Se laws, and ule's and regulat' ns of the San Joaquin Local Health District. 5i ( gned} " ------ 0 ---- -Y"A--�-'-- - ------------------ ----------- ------ Owner and/or Contractor) --- ----- ---- gr '- -- ........................(rtle) ----------------------- (Plot plan, showing size of lot, location o system in relati o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY------------------- - DATE------ f REVIEWED BY ----�'� ------------------------------------ DATE BUILDINGPERMIT ISSUED------------- ------------ ------------------------------------------------------------ DATE-------------------------------- --------------------------- Alterations and/or recommendations------- -------- -------------------- --------------------------------------------------------•-••----•--------------------•---------------------------------- ----------------• - --- ---------- --- ------- --------------------------------- -z�------- ------ ------------I--------- ----------------------------••----------•-•------------•-------------------------------------------------------- -----------------------•---------------------------------------- a/�Z FINAL INSPECTION BY:-- _-___.___ Date____ .__-�f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Co.