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APPLICATION FOR SANITATION PERMIT Permit No. .../-, _F3--7 (Complete in Duplicate) This Permit Expires 1 Year From Date Issued ate Issued ____- 3�G-! Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549., . 'S. JOB ADDRESS AND LOCATION__+-� 6� -- -K[ _. Owner's Name_______ ------- ,° Phone----Address--------- Q- - ----------------------------- ----------- Contractor's Name____ _ __ 1 t - --F.: ----------------- Phone-- ---- Installation will serve: Residence 1 Apart ent House ❑ Commercial E Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_- Number of bedrooms _9. Number of baths ___f___ Lot size Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam N Clay Loam b Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes E] No)� New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septtic( Tank: Distance from nearest well-I �_Distance, J fromfoundation-____-1 No, of compartments---------- - --------- � -�Liquid dep_th--.-M----a--te�r/iaCapacity ------6 -- Disposal Field: Distance from nearest well------`^~-----Distance from foundation.__-_//)---- -----Distance to nearest lot line__/a Number of lines---------------e�?------___ -_ Length of each line_--___ 4_�_�` d�Width of french_______t Type of filter material---- --- - - ---- ----Depth of filter material -__---1_k ----Total length---------,/_;�0-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation____________________Distance to nearest lot line_-____-___-_---- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------- - ----- Cesspool: Disfance 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)______ ' ------- Lr ---- --------------------------------------------------•-------------•----------------------------------•--------------------------- I hereby certify that I have prepared this application and that the work will be dans in accordance with San Joaquin County �L ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 4 m �~ (Signed) - ----- -------(O d/or Contractor) By:-------�� e�r.�----0+------ U,V'l a—p-- ------------------------------------------------- (Title) — " - - ---------� ---- -- ------- - - - ---- ----- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_. _- __ _- - 0 /_P �' '' ------------ -------------------•--------------- --- DATE__ ------------------- REVIEWED BY----------------------------------------------- ----- --- DATE- -- - ----------- �-------------- ------------------------ - --------------------------------------- UILDING PERMIT ISSUED-------------------------------------------- ------------------------- DATE Alterations and/or recommendations---_-- ____-------------_---._ _ -----------------------------------------------------------------------------------•------------------•----------------------- -----------------------------------------------:-1------------------------------------------------------------------------ ------------------------------------------------------------- --- FINAL INSPECTION BY�.-.- ^----- - ----------------- -------- Date-----e�- --- ---------------------------------------- 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.P.Cc. i