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A,, LICATION FOR SANITATION PERPTT Permit No. .__��,.�/.E. ...7 (Complete in Duplicate) y�-- This Permit Expires 1 Year From Date Issued / ate Issued ___..///________________ 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. �� JOB ADDRESS AND LOCATION__+_E•--C (TL"cc �-_•-, .c _.9�.:.-•_f[YIi�-.___-__-_ ,.� � h _ Owners Name----- --4------- r �•--•--- ________. - I _ Phone.__ Address ----- .. . _ = •----- ................................................... PhoneContractors Name T:7 1/ eS/D S - - ---------•-• ----- ---•-_- ------------------------------- Installation -----------------• •--- Installation will serve: Residence Apartment House ❑ Commercial L] Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: _ __ ___ -tNumber of bedrooms __. _ Number of baths ---Z-_- Lot size __.. r ..........-----_------------ _-___ Water Supply: Public system a Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam N Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ 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.) Septic Tank: Distance from nearest well_!_ __Distance, from foundation-------�_0------ L/ i SLG"--- --- •- No. of compartments._.._-__ ._____..__Size 'XX__- ---Liquid depth--- --__-____-Capacity....Y_a-_Q.:�a -____- -__Distance from foundation______ / ' Disposal Field: Distance from nearest well. 1j)---- to nearest lot line__�__a.___._.__- Number of lines-___________________________ Length of each line______'S�4____f �4.-.Width of trench-__-____ _.______--.--__._._ rn i Type of filter material---- _�___ -___Depth of filter material_-__-_�_k/!___..Total length--------I_'- l!_____________________ 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___-__.-__________________________-____-_-- ❑ Distance to nearest lot line------•----•-•-•---•---•-------------•------------•-------___---•----•---------J---------•-----------•-----------------------------------,-i--,-.-%- e):----Remodeling and/or repairing (describh•Q-2 - --------------------------••---••------------------------------• ----------------------------------......................•----------- ---------•--------------- --•-------- --------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- --•--•-•----------------------•-----•------------------------------------------------------------•-----------------------------------------------------•--------•-•--------------------------------------------- v I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County -� ordinances, State laws, and rules and regulations of the San Joaquin Local Health District_ "Ie ----l.r�t. _ _' Owner,&nd or Contractor (Signed)-------- �--�-------- ----• . /C�.---�------�=`==�'`--z=�-'�'-`-------------------------------------------- -----( / ) f� BYL „z,?f �. -.��z - --------------------------------(Title) - _ (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-... ------------ - --------------------------------------- DATE__/s_ / ---t -------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------- ............... Alterationsand/or recommendations:----__-----•--___-•----------------------••----•----•-------------------------------------••---•----------------------•------------•------•-----------_------ ----------------------------------------------------•----------------•------••--•-----•-......-------•--•---------••--••-•------------••-----------------------••--......•--•-...--•-•-------------------•--------------•---- -- ------- ----- ---- ---------------•------------------•••------•-----••-----•-----•- -------•----------------------------------------------------•-------------------•-------------------------•--------------------_---•-- - ---------------•----------•--•---------------_------•---------•-------------------------------•------•------••---- -------------------------------- ---------------------------------................................ - --- ------------------- ---------- - - FINAL INSPECTION BY a: � CYC �� -� ----- - - ------------ 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 ES-9-2M Revised 8-'59 F,P.Co.