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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /d This Permit Expires 1 Year From Date Issued Date Issued _________ --6 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, �2_q(o 3 3 s_ 7,0-4-GY Q L a 6 . �QJOB ADDRESS AND LOCt�1TION-------- .1��4:G-- ---___--- ��/LG'..��._s�1 .''"'-/1�_.�Q/��------------------------------------ - Owner's Name------------L-:.,_ry---..._49..1'5......--------fZ G_Y_. . ------------------- Phone--- •------------------------------ Address--------------------- ------------•--•---Address---------••---------- l. ---- --------------------------------------------------------------------------------------------------------------------------------------------------- S ------- --------------------------------•--------------------------•----------.-.------------•--- �� v � Phone........Contractor s Name-------__ f -- _ ---- '_-_ Installation will serve: Residence ❑ Apartment House ❑ Commercial JPK 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 _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay Adobe❑Hardpan ❑ Previous Application Made: Yes ❑ No L'/ 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.) r Septic Tank: Distance from nearest well-46—we--__Dista--nce from foundation__1p----------Material --f-_-'6.-.---`-�C apa --�---7---P----P------------ No. of compartments----------. ---___---Size- � -_•-- -._--Liquid depth----. I--- .^f Disposal Field: Distance from nearest wellDistance from foundation__Z0_r...---Distance to nearest lot line_4......... Number of lines--------/-_______________________Length of each line------ 4W----__-_--.Width oftrench_. �r____--___--__-- Type of filter material-------------------------Depth of filter material-__-------------------Total length_-__--__.____--_._..--.__...__--________- � Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_--_----._-.-- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------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------------------------------------------ 0 Distance to nearest lot line------------------------------------------------------------------------- ----------------------------------------------------- ---- Remodeling and/or repairing describe):--_ ------------ - -------------- 61' ...........- r ._.:.- ------------- -------77------ -- - - -------- - ------ ----- � - r. ------------------------------------------------------ -----------------•------- --------------------•------------------------------------------------ - I hereby certify t at I have pr eparedtion and that the work will be done in accordance with San Joaquin County ordinances, State I and rrs ane San Joaquin Loc Health District. Si ned `- -----"i-- ----"------------(Owner and/or Contractor) ( 9 )------ - r --- BY:------------------------------------------- ---------------{Title)-- -------------- (Piot plan, showing size of lat, locatlaflon to wells, buil etc., can be pl ed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ----- DATE r > ------------- REVIEWED BY--------------------------------------------------------- !� ---- �--- ----------------------------------- -----'--• DATE------------------------------------------------------ ---- BUILDINGPERMIT ISSUED------------------------------------------------ -----------------------------------------------•---• DATE---------------------------------------------- -------------- Alterationsand/or recommendations:---------------------- -- ----------------------------------•--•--------------------------------------•-------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------- ---------- ----------------------------------------------------------------------------------------•-------------------------------------------------------------------------••-----•------------------------------ ------------------ ---- - --------------- ------- - -------------------------------_..-..-----.------ -------- ------------------•- ----- -- . ---- --------------------- - --------- --------------------- ------------------------------ FINAL INSPECTION BY---------------------- ----- Date----------------------/ ------- ---------41----------------------- 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 R� iced 8.'59 F.P.Co.