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APPLICATION FOR SANITATION PERMIT Permit No. ...L (Complete in Duplicate) Date Issued ___V_VAv This Permit Expires 1 Year From 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. df i — 65-0—c-{_,� JOB ADDRESS AND LOCATION - � '� =` a .-�--- -------------- --------------------------------------- Owner's Name --------------- Phone Address-----•-------------- ---------------:-------------_------------------------------------------------ ----------;----------------- ----•--------------------•- Contractor's Name-- ,. �•t�.4., ------�jT °',., a r-------------A17 .0 ------ -- -•------ ----------- Installation will serve: Residence E] Apartment House ❑ Commercial E] Trailer Court Ll Motel El Other a] �. Number of living units: --- Number of bedrooms _____ -- Number of I'atlis _:.2_.�Lot size ._.1- --3'___6_d________________________________ Water Supply: Public'system X : Community system ❑ Private ❑ Depth to Water Table kb_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,3 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes 0 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__1-Q----------Material-__ _...-------- No. of compartments---- -----------------Size--- t_47k_3--------.-Liquid depth-------y�-.-----------Capacity..��__.-------- p fid _'_____ Distance from foundation__ _C1_'______-_--Distance to nearest lot line__5 -------- Disposal Field: Distance from nearest well _ _ / - Number of lines- _.__/_----------------- DO Length of each line---1-4!7v_'_______-_._ Width of trench___ Y_"___________________ Type of filter material —_ ----Depth of fialter:material-__.-1 -------Total length----/, V--------._____ _____________ � ,W,W Seepage Pit; Distance to nearest we I_________________ ____Distance from foundation____________--_.___.Distance to nearest lot line.--._.--_____..__ {dumber 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-- ----- -----------------------------------------------------------•-----•---------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------- ---------------------------------------------- =' ---•-•----- ----------------- 1 ---------------------------•---------------------------------- -----------------------------------------------•----------------------------------------------------------------------------------------------------------- - I ---------------------------------•---------------------- ------------------------•----------------------- 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. (Signed)---- ------------------------------------------------ ---------- --------(Owner and/or Contractor] By:-------------- ------------------------------------------------------------------------------------------------------------------ -(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- - ------e ---------------------- ----------------•----------------------- DATE----lsr'"2 ��°p----------------------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------- ------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- ----------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------- -------------------------------------------------------------------- ------------------------•-------------------------------------------------- ------------------- -----------•-----------------------------------------------------------------...---------------------------------------------------------------- ---•-------••---------•------------------------------ ----- ---------- r ---------------- FINAL INSPECTION BY:��:� ---- -- Date----- ��p I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stocktan, California Lodi, California Manteca, California Tracy, California ES-9—.2M R2 ,ised 8-'59 F.P.Co.