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APPLICATION FOR SANITATION PERMIT Permit No. ..... ........... {Complete in Duplicate} This Permit Expires I Year From Date Issued Da+e Issued n_ Application is hereby made to the San Joaquin Local Health District for �© t �7 9 permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549.;Roo AAA l�N� - - - JOB ,ADDRESS AND LOCATION---------��-�---�--- A`�`z�� ✓�--!^� PN`se�o��.P�P�ce1iA�/4V � � -------- Owner's Name-------------- Address ------ ---- --------•----- a � u � Address ,- -----------------------------------•-------------------------•------------------•----------------------- Contractor s Name------------------- cape------------------ - -------------•---------- ---- Phone---•--------•------------- - - --------------------------- -------- Installatiori will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units..---/-- Number of bedrooms __�3._ Number of baths/ Lot size ____1�1,51477___Y___1� —_3 -------- Water, Supply: Public system ❑ Community system ❑ Private jg� Depth to Water Table -------- ft. I Character of soil jo a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe [] Hardpan ❑ Previous Application Made: Yds ❑ No [K New Construction: Yes JX No ❑ FHA/VA: Yes ❑ No [ t TYPE OF INSTALLATION 'AND SPECIFICATIONS: 1 (No septic tank or cesspool'permit+ed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__f�_`� Distance - --f--- foundatiLiquid n_ dMaterial____ ---- No. of compartments---- -42--- -------Size-------- qui e th__------------------------Capacity-.-X06_- ®-��-.-a--�-- I Disposal Field: Distance from nearest well' /0D.-._Distance from foundati fP ____/ __ Distance to nearest lot line____3_______-_- " Number of lines_______________ . --------------Length of each line-,ZA _ I Width of trench_ y _________._ Type of filter material------__�__a_c/�____Depth of filter mater:a___._�_`d__________-_Total length___________________/ jo-----------_------ Seepage Pit: Distance to nearest weft_Z0.4_/z4----Distance from f undation_-W------ -.___Distance to nearest lotPQ / Number of pits_ _ -2--------Lining material---- --------Siz6: Di6mee'i-3��- ------------.Depth---- ----_-_-f Cespool: Distance nearest wellDistance from foundation-. innmaterials _ Diameter - ----------------Depth ---------------Liqud Capacity---------------------------- als' 'W Privy: Distance from nearest well-----------------------------_-------------------Distance from nearest building__________.____________________---------- ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------- ---------__ •----------------------------------------- -------------------------------------------- --------------------------------------------•--------------------------------•-••----------=-------------•••------------------------------------------ ---------------------------- I �C ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- I hereby certify a I have repared this applicatidn and that +he work will be done in accordance with San Joaquin County ordinances, State 1 an r s nd reg ons the San Joaquin Local Health District. (Signed)= =-------------------- ' - ---------------------------- - --------------- -----{Owner nd/or Contractor) BY: ----lo ------------------------------------------------------------------------------------------(Title-------0-7- ----- ------------- - -- ---....------ (Plot plan, showing size of 1 location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY A PLICATION ACCEPTED BY -------------------------------------------------------- DATE------3 sCD REVIEWEDBY------------------------- ------------------- -------------------- -------------------- ------------------------------------- DATE------------- ---------------------------------------------- BUILDING PERMIT ISSUED------------------------ ----------------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------•-------------------- ----- ---- / / -----------------------•-------•---------------•-------•---•-------••-------------------------- Q -- ------------• ------------------•---------�'-•-•------------------------------- -------------------------- -----°-------- - ----------------------- ---------------------------------------------- -------------------------- ------------------------------ --------------- -------- FINAL INSPECTION BY:-29-- , -- - ---------- - ---------- Date------- 9-.1.7 - �Q 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 ES-9--2M Revised 8-'59.F-.F.co. +�