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U P APPLICATION FOR SANITATION PERMIT Permit No..t..-..'..`.� (Complete in Duplicate) d -Y 2, This Permit Expires 1 Year From Date Issued 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.,,0 ��S"/!3�C�j sUe, JOB ADDRESS AND LOCATION_____ II / Owner's NameY�4lL-�-----. Phone --- v------•---- Address---------------------------------Gt-or Contractor'sName ,,?a -V ��;��e&--=-----••---------------------------------- - Phon �'_�_K Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Gourt ❑ Motel Other.[]/ Other. Number of living units: ---- I. Number of bedrooms -Z- Number of baths ___,f _ Lot size .�� iI`,F��l------------------------- `• Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table-_Ift. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yesvo ❑ FHA/VA: Yes ❑ No p+' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T�nIC: Distance from nearest well--tiY.??----__Distance from foundation ---- f_0._r_- - Material- 0-AR."e kI------------------ No. of compartments._.... ;L --- ---------- size ._.-_*$-iXyd--------- Liquid depth ------ �!T.—.___---..Capacity-----�--------- Dis osal Field: Distance from nearest well..��1_-.i Distance from foundation_ ___ l p _- _ �! _._______Distance to nearest lot line__�l__r__.__.._____ Number of lines ----------- I --------- ----- ------ Length of each line __.____..9j'_ a f ______________Width of trench_.��___1____ Type of filter material ____�_C_>-.____Depth of filter material__/ -.8-.'1 ---------- Total length ______,l`__Q_r__ _________--------- 1 i Seepage it: Distance to nearest well ---- �_(O}________Distance from foundation__,/O__.i ..... Distance to nearest lot line____--._--_ Number of pits ------- I_____.._____Lining material__Y'041� ---- Size: Dia meter.:_..?-_ ..... ..... Dept h.....�s_ _____________ Cesspool: Distance from nearest well_________________ Distance from foundation --- -_----- ----- ---_Lining material ------------------------------------- El 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):--------- ------------- e� ��-------.----- ------------------------------ -----------------------------•---------------------------;-----------...------------------------------------------------------------------------------------------------ --------------•------- ----------------------------------------------------------------------I- -------------------------------------------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San JoaquhT County ordinances, State laws, and rules and regulations o e San Joaquin Local Health District. (Signed)------------------------ u ` --------------x - - -- --- ------------- - -------------------- ------- and/ r Contractor) By:----------------------------- ---- --JY� (Title) _. .. ---- ----- (Plot plan, showing size of lot, tion of ystem in relation to wells,_buildings, c be placed on reverse side]. FOR)�EPgTMENT USE ONLY APPLICATION ACCEPTED BY___`. - �(�. DATE r --------------- REVIEWEDBY --------------------------------------------- - -------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE ---------------------------------------------- -------------- Alterati s and/or recommen ------------------- - Wit - - - ------ --- -4 , - = -------------------------------------------------------------- -------------------------------------------------------------------------------------•--.--- ---------------------------------------------------------------- ----------------------------------- ------ -- .---------------------- FINAL INSPECTION BY------ -- - - ------ ----- - -=------ Date --------.-- ` ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.p,Cc.