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/M APPLICATION FOR SANITATION PERMIT Permit No. �?- ..Z- (Complete in Duplicate) Date Issued ---•-.-'�- --,�--p--• � 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 wit ount Ordinan e No. 549. ale S; ? �C _ Hr6,k- V� Zb JOB ADDRESS AND O� AT N ------ t �Q_3� -- -- ------- -------------- ------- ------- - -------- ---- JOB O - - --..._.... J� Owner's Nam JCrr ----------------------- Phone-------------------- Address----•------•------ - Contractor's Name----------------------_ ----- - ---•- --- --- --'- ----- -------r----------------------------------------------- Installation -----Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other - •�� Number of living units- -------- Number of bedrooms -------- Number of baths -------- Lot size -------------------_-------.- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table f!O__ ft. 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: Yes ❑ No t^ FHA/VA: Yes ❑ NoX- TYPE OF INSTALLATION AND SPECIFICATIONS: �c (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) S is Tank: Distance from nearest well-----------------Distance from foundation____--_-----------.Material-----_.--.___-_-------_- ' ------- ------- No. of compartments----- -------- - --Size--------------------------------Liquid depth--------------------------Capacity-------------------- r .5� Disposa Fi Id: Distance from nearest welly-.------Distance from foundation___.5,D----_.Distance to nearest lot line-/----------- Number oflines---. _---__--- Length of each linelS -,3S__j------.Width of Type of filter material-S!-__------_-____,_Depth of filter material-----Z?_11---------Total length-----lSd------------------- .._- Seepage : Distance to nearest ellls G -__ •-_Distance m f ndation__ �------------r -- Die a ce to nearest lot line-- S� Number of pits.-- ---.-------Lining material--__.Size: Diameter----- ----_ p o� --------Depth c ---------------- 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 fine------------------ Remodeling and/or repairing (describe)------------------------------ i ----------•-•--•--------------------•---------•---------------•------------•--------------------------------------------------- --------------------------•------------•---------------•-----------•--------•------------------------------------------------------------ r� I hereby cerfifv that I have preOre his application and that the work will be done in accordance with San Joaquin County ordinances, Sta e I s, and ul s acid re ations of the San J quin Local Health District. (Signed)-------------- ----___-- --- --- -_--- -- .(Owner and/or Contractor) -- �it��-- �r�}� By: -- (Title) ` Qf{._ (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- -----------------------------------------••--- DATE----- - _ . ,� y• ------------------------- totREVIEWED BY DATE . - ----------------------------- UI DIN PERMIT ISSUED ------------------------------------------------- ------ DATE-------------------- Alterations and/or recommendations-------- -------- 3- -moi -s - /s�---------------- 1 Q�i�l r - 7-------- � 7 -•- _ a �` E��`-r-----G �%Q/+�/f.F G -----•-•-----------•------------•-•-----------•----------•------------------------- -- ---------------------------------------•-------- -----------------------------------`� f f -F =--------------------------------- ----------------------------------•---- FINAL INSPECTION BY-----------------------------/---,'f:--' -------------* -/ f,�. 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 E5-4-2M , Revised 1-57 F.P.CO.