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APPLICATION FOR SANITATION PERMIT Permit No. .�l_.��__-_ }t Q t (Complete in Duplicate) Ff U This Permit Expires 1 Year From Date Issued Date 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, /f JOB ADDRESS AND LOCATION.. ', ----`"s1--------------4—-�j---------- Owner's Name--------------- /4-1i , Address------------------------- ------ -- Phone------------------------------------ - �-�--'--'-- -- �r--=- Contractor's Name---- ----------- ------------•- -------------------------------------- Phone.----- ---.-•---------------------- Installation will serve:j Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�__- Number of bedrooms 4�%-- Number of baths _-/-- Lot size _- -. � Water Supply: Public;system ❑ Community system Ra"Private ❑ Depth to Water Table -� `ft- Character of soil. to a 'depth of 3 feet: Sand {] Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe 2--Hardpan ❑ Previous Application Made: Yes ❑ No E'��New Construction: Yes �lo ❑ PHA/VA: Yes Z]'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � _--. Septic T k: Distance'from nearest well--------------- -Distance from foundation_- .--.Material No. of compartments-----�-----------------Size--,.--- -- ,---Liquid depth---- ---- -____Capacity---l��4,:�7----- i Disposal ield: Distance from nearest well.___'__.---Distance from foundation.-_��'-.__-Distance to nearest lot line---�- --... ; p' Number of lines._- Length of eachlineae%-�_' -- a Width of french---- -- Type. of filter materiaL_�'K'XY) Depth-of-filter-material-,/9---------.Total length...... -- -------------------- Seepage if: Distance to nearest well_________ __ _Distance fr m foundation,_-l�'.i_-74'-Distance to nearest lot Vill Number of pits--------2- --_-------Lining material--f _��5ize: ;Diameter.--�,.�---- -----..Depth--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_----..---.------_.--_----_-_-_-_-- ' ElSize: Diameter Depth ---------------==------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__----------------------------------------------Distance from.nearesf building---____-----_____---------___. ❑ Distance to nearest lot line-----------------------------------------------------------------------r------------------------------------------------------------------- - Remodeling and/or repairing (ddscrilje)------------- i -t2f_ Z�i_ 1 .- ----------------------------------------------- ---------------'------------------------------------------------------ ---------------------------------- ----- i ---------------------- '- --------------------------------------------------------------------------------------------------------------'------------------------- •"'"--------'------------- --`-'--'-"---'----"'-'--'--'--__-_--....._______.-'-- I hereby certify that I have prepared this app)ation and that the work will be done?in accordance with San Joaquin County ordinances, State laws, and rules and regulations +if,-t'he San Joaquin Local Health District,, (Signed)-------------------- '" ---- - Einer.-rs,d/or Contractor) • ----------- --------- (Title) (Plot plan, showing size of lot, location, system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY------------- kC� ` = ' DATE " ` U----97---- ---- --------------------- REVIEWEDBY ---------------------- - - ----------------------------------------------------:------------- DATE------------------------ ------ - --- -----•--------- BUILDING PERMIT ISSUED------------------------------------------ !------------------------------------------- ------------ DATE. Alterations and/or recommendafions:----------------------- ' ------------------------------•------- rw. C . y FINAL lNSPECTI ---- ----- ---- �� Date-- SAN JOAQUIN.LOCAL HEAL H"DISTRICT, 130 South American Street 300 West Oak Sfreef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co, i