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yPermit No. ..__.1.r1.9_ ... APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) Date IssuedThis Permit Expires 1 Year From Date Issued d�$^ j fee—f 4' ,2 2-3 q f ,� gr7 h Application'is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work erein described. This application is made in compliance with ounty Ordinance No. 549. h f � � � � . . __.. ...... ..�_.. w.._ _. - . � . JOB ADDRESS A LOCATION-1--� --- ------- ---��-... ... Owner's Name...... .�.... e d� .....................------------------•-------------------------------------------............ Phone.-..... Name.. c ._R_ --• ---.....-•------------------------------------------------..-- ••---•..... ------ I ..............------_-----_-_-- Contractor's Phoneer -- Installation will serve: Residence ❑ Apartment Houie ❑ Commercial ❑ Trailerp,�CCourt ❑ Motel ❑ Other Number of living units: ........ Number of bedrooms........ Number of bathso�t�..`:"Lot size 'G.�_..-.-------••----•••-----•--•---- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan[f�` Previous Application Made: Yes ❑ No [ 'New Construction: Yes ❑ No �HA/VA:Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti k: Distance from nearest well..........°------Distance from foundation.................. Material................................................. No. of compartments_. :-�-t----------Size.-•------------------•----- Liquid//depth_.......--.._.. Capacity----•-•--•---..------- Disposal Fi d: Distance from nearest well.PA...:--.Distance from foundati n....l. _. ......Distance to nearest lot line----------------- Number of lines.......____..-.-__.. Length of each line..... :l .�....�_..__.Width of trench_.... 5! ................. Type of filter material_....4�F Depth of filter material.---.5C.--_-...Total length....-__3.o..................... Seepago. Pit: Distande to nearest ...Distance m foundation... . ...........Distan�-9 to nearest lot line_-.5---------- Number of pits------J-------------Lining material..... /�'_..__Size: Diameter------3.3..-----..Depth----;i?-� ................. 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.-_--;--__---_------_----_-__----._..-. 1] Distance to nearest lot line----_------------------------- -•...................................--------------_........................................................ Remodelingand/or repairing (describe)-------------------------------......................................................-------------•--------....--.................----_..._..---•-------- ...................••----•------------------------------------------...............•............................................-----------------------------------•-..........----------------------------------------------- f1 ---------------------------------------••---•-------•--•-•-•--......---..------•-•-------------------------.----------------------------- -•--•.......-----------------....---•-•-----....._.....__.... . ....................................................................................................................... ------------•---------• -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , e laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �� r 1 I} ¢ a f�.5.-•-•---•-._..•-------------------------....----.--------••--:---.....-----------•----••---•.......... (Owner and/or Contractor) By:...................... i.11.._1l/1_ .,/t-----.-----------------------------------------------------------------------(Title)........ 5-----------..-----------_- ----••----------- (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.._ _...... . :�;�-------------------------------------.-----------........ DATE-s- 'k_b.._..._---•--• REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE._....-•---..._......------...-•--•-------------•------..... BUILDINGPERMIT ISSUED----------------.............................---------------....................................... DATE---............I.............. ----•.............I......... Alterationsand/or recommendations:-----------------------------------------------------:...........-----•---• - ---------._..._.........................----•_...................... i .................................................................................................".-----------•.......................................................................................................... ...._ ................_-.-.-.--........--------•----•--------------------_--...---......----.......-_------.......--_-_•-•....--••---_----....------......•..._--.------.----...--._...---........-------------------------------. FINAL INSPECTION BY:.- . - .................... Datel�,r_ ....................................................... SAN INSPECTION BY:_,-,;;�_� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Waif Oak Street 132 Sycamore Street 814 North "C" Sheet Stockton, California Lodi, California Manteca, California Tracy, California { {r ES-9-2M Revised 8-•59 F,F.Co, 1 4